UTI therapeutics Flashcards
Cystitis
-lower UTI (bladder, urethra, urine)
classic triad of symptoms in cystitis
dysuria
frequency
urgency
pyelonephritis
-upper UTI (kidneys, ureters)
physical symptoms of pyelonephritis
- may included classic triad
- fever
- flank pain
- CVA tenderness
lab indicators of pyelonephritis
- urinalysis showing >10 WBC/hpf
- urine culture showing >100,000 cfu/mL
- leukocytosis
uncomplicated urinary infection
- always female
- no anatomical or neurological impairments
- treated with oral therapy
complicated urinary infection
- all males, selected females
- anatomical/neurologic impairments present
- treat with IV or oral therapy
bacteria that cause uncomplicated UTI
- E.coli 75-95%
- S.saprophyticus 5-20%
- other Gm- 5-10%
- enterococcus 5-10%
bacteria that cause complicated UTI
- <50% E.coli
- >50% other GNB; staph and E.faecalis are common
risk factors for UTI
- female anatomy (short urethra)
- sexual activity
- diaphragms and spermicidal agents
- menopause
- urinary tract anomolies
- obstruction of urinary tract
- suppressed immune system
- catheter use
most common bacteria in community acquired UTI
E.coli
Proteus
Entercoccus
most common bacteria in sexually active female
- staph.saprophyticus
- E.coli
- Proteus
- Enterococcus
most common bacteria in nursing home or hospital acquired UTI
- E.coli
- Proteus
- Entercoccus
- other GNB
- Staph
elements of urinalysis
- specific gravity
- protein
- glucose
- ketones
- bilirubin
- RBC
- WBC
- bacteria
- casts
- nitrite
why nitrites are looked at in urine
bacteria reduce nitrate to nitrite
when to do a urinalysis
if they are symptomatic of UTI
When are urine cultures done
-usually not after 1st UTI
specific populations that we do urine culture for
- pregnant females
- elderly patients
- diabetic pts
- immunosuppressed pts.
- males
- recurrent UTI
- catheter
- upper tract infection
when are blood cultures done
if the following are present
- fevers
- hypotension
- N/V
- upper tract infection
- recurrent urinary infection
- diabetics
what do we do if patient has positive urinalysis, but asymptomatic
do not treat
patients we treat when no symptoms are present but positive urinalysis
- pregnancy
- children w/ risk factors
- neutropenic patients
- post renal transplant patients
- patients undergoing urologic procedure
3 day therapy for uncomplicated UTI
- usually done
- TMP/SMZ
- cephalexin
- cefuroxime
5 day therapy for uncomplicated UTI
- nitrofurantoin
- TMP/SMZ
- various Cephs
standard empiric choice for cystitis
TMP/SMZ
unless resistance in area is >20%
back up option for acute uncomplicated UTI
quinolone for 3-5 days after other options are exhausted
collateral damage
- killing bacteria that were not involved in the UTI
- leads to resistances of other potentially infectious bacteria
collateral damage led to the emergence of what baterial strains
- VRE
- KPC pathogens
- clostridium defficile
- resistant Acinetobacter
- SPACE pathogens
TMP/SMZ cystitis dosing
1 tab q12h for 3 days
cephalexin cystitis dosing
500 mg q6h for 7 days
cefdinir cystitis dosing
300 mg q12h for 3-7 days
cefpodoxime cystitis dosing
100-200 mg q12h for 3 days
amox/clav cystitis dosing
500 mg q8h for 5-7 days
fosfomycin cystitis dosing
3 gram for 1 dose
nitrofurantoin cystitis dosing
100 mg bid for 5 days
nitrofurantoin cystitis contraindication
CrCl under 30 mL/min
ciprofloxacin cystitis dosing
250 mg q12h for 3-5 days
levofloxacin cystitis dosing
250-500 mg q24h for 3-5 days
treatment duration for males
7-10 days
treatment duration for males with prostatitis
4 weeks
UTI antibiotics with low risk of emergence of resistance and collateral damage
nitrofurantoin
fosfomycin
treatment plan for outpatient pyelonephritis
- UA, urine culture
- oral therapy if no N/V
- tmp/smz
- cefuroxime
- cefpodoxime
- amox/clav
TMP/SMZ dosing in outpatient pyelonephritis
1 DS bid for 7-10 days
cefuroxime dosing in outpatient pyelonephritis
500 mg q12h
cefpodoxime dosing in outpatient pyelonephritis
200-400 mg q12h
amox/clav dosing in outpatient pyelonephritis
500 mg q8h
OR
875 q12h
quinolones to use in outpatient pyelonephritis
ciprofloxacin
levofloxacin
usual pathogens in pyelonephritis
e.coli enterococcus proteus klebsiella pseudomonas
drugs for inpatient pyelonephritis
- piperacillin-tazobactam
- ceftriaxone
- ceftazidime
- cefepime
- ciprofloxacin
- ampicillin/gentamicin
- ertapenem
generally treatment plan for pyelonephritis in hospital
treat IV until pt is afebrile for 24-48 hours, then complete 7-10 day oral course
prostatitis pathogens
- enterobacteriaceae
- enterococci
- P. aeroginosa
prostatitis treatment plan
- for 4 weeks
- TMP/SMZ 1 DS bid
- cipro 500 mg bid
- levo 750 mg qd
how long to treat if recurrent prostatitis
at least 6 weeks
treatment for nosocomial UTI
- treat for 7-10 days
- ampicillin
- ceftazidime
- cefepime
- peperacillin-tazobactam
- cipro/levo
- ertapenem
- vancomycin
quinolone that can be used for outpatient pseudomonas
ciprofloxacin
treatment for Candiduria
- fluconazole 200 mg po/IV qd for 7-10
- amphotericin B bladder irrigation
candidates for UTI prophylaxis
- uncomplicated urinary tracts
- at least 3 UTIs yearly
- children with vesicoureteral reflux
UTI prophylaxis drugs
- TMP/SMZ 1 half tab qd for 3 weeks
- TMP
- methenamine
- nitrofurantoin
- norfloxacin
postcoital UTI prophylaxis
same drugs as general UTI prophylaxis drugs but a one time dose
UTI suppressive therapy
treat initial UTI but urine will not become sterile due to
- urinary stones
- urinary structural defects
- neurogenic bladder
suppressive UTI regimens
- TMP/SMZ
- nitrofurantoin
- norflaxacin
antibiotic counseling points
- complete entire course
- drink at least 8 oz water w/antibiotic
- ADRs
