UTI Treatment Flashcards
what are the most common gram negative pathogens for uncomplicated UTIs?
UPEC and K. pneumoniae
what are the most common gram positive pathogens for uncomplicated UTIs?
S. saprophyticus and Enterococcus
what is the first line treatment for uncomplicated UTIs?
Nitrofurantoin OR TMP-SMX OR Fosfomycin
What is the first line treatment for uncomplicated UTIs in patients at risk for MDR gram negative infection?
Nitrofurantoin or Fosfomycin
what is the MOA of TMP-SMX?
inhibits bacterial DNA replication
what are the toxicities associated with TMP-SMX?
avoid with pregnancy and in patients with HIV
what is the MOA of fosfomycin?
inhibits bacterial cell wall synthesis
what is the MOA of nitrofurantoin?
inhibits bacterial protein synthesis, aerobic energy metabolism, and DNA,RNA, and cell wall synthesis
what are the toxicities associated with nitrofurantoin?
C. difficile superinfection, drug-induced liver injury, polyneuropathy, and pulmonary toxicity
what is second line treatment for uncomplicated UTIs?
one of the following beta-lactams: amoxicillin-Clavulanate or Cephalosporins
what is the MOA of cephalosporins?
they disrupt bacterial cell wall synthesis
what are the first generation cephalosporins used as a second line treatment for uncomplicated UTIs?
cephalexin and cefadroxil
what are the third generation cephalosporins used for second line treatment of uncomplicated UTIs?
cefpodoxime and cefdinir
what is the third-line treatment for uncomplicated UTIs?
fluoroquinolones: ciprofloxacin or levofloxacin
what are the common adverse effects of fluoroquinolones:levofloxacin?
tendonitis and tendon rupture, CNS effects, exacerbation of myasthenia gravis
which of the fluoroquinolones are the most potent against gram negative bacilli?
ciprofloxacin
what are the indications of levofloxacin?
uncomplicated UTI, acute pyelonephritis, or prostatitis
what is the first line treatment for uncomplicated pyelonephritis?
ciprofloxacin OR levofloxacin (so start off with fluoroquinolones right off the bat)
if a patient has an uncomplicated pyelonephritis but resistance to fluoroquinolones, what is recommended?
an initial dose of ceftriaxone or aminoglycoside 24-dose
what is an alternative first line treatment for an uncomplicated case of pyelonephritis?
TMP-SMX (if susceptibility is unknown, then initial dose of ceftriaxone OR aminoglycoside 24 hour dose is recommended
what are the most common gram negative pathogens to cause complicated UTI?
UPEC and K. pneumoniae
what are the most common gram positive pathogens to cause complicated UTIs?
enterococcus
what is the first line treatment for patients with a complicated UTI but not requiring intensive care or suspected obstruction?
ceftriaxone, piperacillin-tazobactam, ciprofloxacin, OR levofloxacin
how do you treat a patient with a complicated UTI who is at risk for MDR infection?
piperacillin-tazobactam, imipenem, meropenem, OR doripenem
what should you add to a patients treatment for a complicated UTI if you suspect they may have a drug-resistant gram positive infection?
vancomycin, daptomycin, OR linezolid
what is the first line treatment for patients with a complicated UTI and who require intensive care and/or suspect obstruction?
imipenem, meropenem, OR doripenem AND vancomycin
how do you treat catheter associated UTI?
as a complicated UTI unless they are asymptomatic, then you do not treat
how do you treat penicillin susceptible cystitis due to enterococci?
amoxicillin OR IV ampicillin
how do you treat penicillin resistant cystitis due to enterococci?
nitrofurantoin, doxycycline, linezolid, or chloramphenicol
how do you treat vancomycin resistant cystitis due to enterococci?
nitrofurantoin, doxycycline, linezolid, chloramphenicol, OR daptomycin
how do you treat patients with candida UTI with an indwelling catheter?
first line: change the catheter, then if persists: fluconazole OR amphotericin B
how do you treat patients with candida UTIs without an indwelling catheter?
fluconazole
how do you treat pyelonephritis due to candida?
fluconazole
when should antibiotic UTI prophylaxis be used and what is it?
only in women with frequently recurring UTIs (>2 in 6 months); TMP-SMX or nitrofurantoin
