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PT2 ID 1-6 > UTI therapeutics > Flashcards

UTI therapeutics Flashcards

1
Q

Cystitis

A

-lower UTI (bladder, urethra, urine)

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2
Q

classic triad of symptoms in cystitis

A

dysuria
frequency
urgency

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3
Q

pyelonephritis

A

-upper UTI (kidneys, ureters)

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4
Q

physical symptoms of pyelonephritis

A
  • may included classic triad
  • fever
  • flank pain
  • CVA tenderness
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5
Q

lab indicators of pyelonephritis

A
  • urinalysis showing >10 WBC/hpf
  • urine culture showing >100,000 cfu/mL
  • leukocytosis
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6
Q

uncomplicated urinary infection

A
  • always female
  • no anatomical or neurological impairments
  • treated with oral therapy
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7
Q

complicated urinary infection

A
  • all males, selected females
  • anatomical/neurologic impairments present
  • treat with IV or oral therapy
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8
Q

bacteria that cause uncomplicated UTI

A
  • E.coli 75-95%
  • S.saprophyticus 5-20%
  • other Gm- 5-10%
  • enterococcus 5-10%
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9
Q

bacteria that cause complicated UTI

A
  • <50% E.coli

- >50% other GNB; staph and E.faecalis are common

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10
Q

risk factors for UTI

A
  • female anatomy (short urethra)
  • sexual activity
  • diaphragms and spermicidal agents
  • menopause
  • urinary tract anomolies
  • obstruction of urinary tract
  • suppressed immune system
  • catheter use
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11
Q

most common bacteria in community acquired UTI

A

E.coli
Proteus
Entercoccus

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12
Q

most common bacteria in sexually active female

A
  • staph.saprophyticus
  • E.coli
  • Proteus
  • Enterococcus
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13
Q

most common bacteria in nursing home or hospital acquired UTI

A
  • E.coli
  • Proteus
  • Entercoccus
  • other GNB
  • Staph
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14
Q

elements of urinalysis

A
  • specific gravity
  • protein
  • glucose
  • ketones
  • bilirubin
  • RBC
  • WBC
  • bacteria
  • casts
  • nitrite
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15
Q

why nitrites are looked at in urine

A

bacteria reduce nitrate to nitrite

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16
Q

when to do a urinalysis

A

if they are symptomatic of UTI

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17
Q

When are urine cultures done

A

-usually not after 1st UTI

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18
Q

specific populations that we do urine culture for

A
  • pregnant females
  • elderly patients
  • diabetic pts
  • immunosuppressed pts.
  • males
  • recurrent UTI
  • catheter
  • upper tract infection
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19
Q

when are blood cultures done

A

if the following are present

  • fevers
  • hypotension
  • N/V
  • upper tract infection
  • recurrent urinary infection
  • diabetics
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20
Q

what do we do if patient has positive urinalysis, but asymptomatic

A

do not treat

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21
Q

patients we treat when no symptoms are present but positive urinalysis

A
  • pregnancy
  • children w/ risk factors
  • neutropenic patients
  • post renal transplant patients
  • patients undergoing urologic procedure
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22
Q

3 day therapy for uncomplicated UTI

A
  • usually done
  • TMP/SMZ
  • cephalexin
  • cefuroxime
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23
Q

5 day therapy for uncomplicated UTI

A
  • nitrofurantoin
  • TMP/SMZ
  • various Cephs
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24
Q

standard empiric choice for cystitis

A

TMP/SMZ

unless resistance in area is >20%

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25
Q

back up option for acute uncomplicated UTI

A

quinolone for 3-5 days after other options are exhausted

26
Q

collateral damage

A
  • killing bacteria that were not involved in the UTI

- leads to resistances of other potentially infectious bacteria

27
Q

collateral damage led to the emergence of what baterial strains

A
  • VRE
  • KPC pathogens
  • clostridium defficile
  • resistant Acinetobacter
  • SPACE pathogens
28
Q

TMP/SMZ cystitis dosing

A

1 tab q12h for 3 days

29
Q

cephalexin cystitis dosing

A

500 mg q6h for 7 days

30
Q

cefdinir cystitis dosing

A

300 mg q12h for 3-7 days

31
Q

cefpodoxime cystitis dosing

A

100-200 mg q12h for 3 days

32
Q

amox/clav cystitis dosing

A

500 mg q8h for 5-7 days

33
Q

fosfomycin cystitis dosing

A

3 gram for 1 dose

34
Q

nitrofurantoin cystitis dosing

A

100 mg bid for 5 days

35
Q

nitrofurantoin cystitis contraindication

A

CrCl under 30 mL/min

36
Q

ciprofloxacin cystitis dosing

A

250 mg q12h for 3-5 days

37
Q

levofloxacin cystitis dosing

A

250-500 mg q24h for 3-5 days

38
Q

treatment duration for males

A

7-10 days

39
Q

treatment duration for males with prostatitis

A

4 weeks

40
Q

UTI antibiotics with low risk of emergence of resistance and collateral damage

A

nitrofurantoin

fosfomycin

41
Q

treatment plan for outpatient pyelonephritis

A
  • UA, urine culture
  • oral therapy if no N/V
  • tmp/smz
  • cefuroxime
  • cefpodoxime
  • amox/clav
42
Q

TMP/SMZ dosing in outpatient pyelonephritis

A

1 DS bid for 7-10 days

43
Q

cefuroxime dosing in outpatient pyelonephritis

A

500 mg q12h

44
Q

cefpodoxime dosing in outpatient pyelonephritis

A

200-400 mg q12h

45
Q

amox/clav dosing in outpatient pyelonephritis

A

500 mg q8h
OR
875 q12h

46
Q

quinolones to use in outpatient pyelonephritis

A

ciprofloxacin

levofloxacin

47
Q

usual pathogens in pyelonephritis

A 
e.coli
enterococcus
proteus
klebsiella
pseudomonas
48
Q

drugs for inpatient pyelonephritis

A
  • piperacillin-tazobactam
  • ceftriaxone
  • ceftazidime
  • cefepime
  • ciprofloxacin
  • ampicillin/gentamicin
  • ertapenem
49
Q

generally treatment plan for pyelonephritis in hospital

A

treat IV until pt is afebrile for 24-48 hours, then complete 7-10 day oral course

50
Q

prostatitis pathogens

A
  • enterobacteriaceae
  • enterococci
  • P. aeroginosa
51
Q

prostatitis treatment plan

A
  • for 4 weeks
  • TMP/SMZ 1 DS bid
  • cipro 500 mg bid
  • levo 750 mg qd
52
Q

how long to treat if recurrent prostatitis

A

at least 6 weeks

53
Q

treatment for nosocomial UTI

A
  • treat for 7-10 days
  • ampicillin
  • ceftazidime
  • cefepime
  • peperacillin-tazobactam
  • cipro/levo
  • ertapenem
  • vancomycin
54
Q

quinolone that can be used for outpatient pseudomonas

A

ciprofloxacin

55
Q

treatment for Candiduria

A
  • fluconazole 200 mg po/IV qd for 7-10

- amphotericin B bladder irrigation

56
Q

candidates for UTI prophylaxis

A
  • uncomplicated urinary tracts
  • at least 3 UTIs yearly
  • children with vesicoureteral reflux
57
Q

UTI prophylaxis drugs

A
  • TMP/SMZ 1 half tab qd for 3 weeks
  • TMP
  • methenamine
  • nitrofurantoin
  • norfloxacin
58
Q

postcoital UTI prophylaxis

A

same drugs as general UTI prophylaxis drugs but a one time dose

59
Q

UTI suppressive therapy

A

treat initial UTI but urine will not become sterile due to

  • urinary stones
  • urinary structural defects
  • neurogenic bladder
60
Q

suppressive UTI regimens

A
  • TMP/SMZ
  • nitrofurantoin
  • norflaxacin
61
Q

antibiotic counseling points

A
  • complete entire course
  • drink at least 8 oz water w/antibiotic
  • ADRs

PT2 ID 1-6 (7 decks)

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