UTI Treatment

Question 1

what are the most common gram negative pathogens for uncomplicated UTIs?

Answer 1

UPEC and K. pneumoniae

Question 2

what are the most common gram positive pathogens for uncomplicated UTIs?

Answer 2

S. saprophyticus and Enterococcus

Question 3

what is the first line treatment for uncomplicated UTIs?

Answer 3

Nitrofurantoin OR TMP-SMX OR Fosfomycin

Question 4

What is the first line treatment for uncomplicated UTIs in patients at risk for MDR gram negative infection?

Answer 4

Nitrofurantoin or Fosfomycin

Question 5

what is the MOA of TMP-SMX?

Answer 5

inhibits bacterial DNA replication

Question 6

what are the toxicities associated with TMP-SMX?

Answer 6

avoid with pregnancy and in patients with HIV

Question 7

what is the MOA of fosfomycin?

Answer 7

inhibits bacterial cell wall synthesis

Question 8

what is the MOA of nitrofurantoin?

Answer 8

inhibits bacterial protein synthesis, aerobic energy metabolism, and DNA,RNA, and cell wall synthesis

Question 9

what are the toxicities associated with nitrofurantoin?

Answer 9

C. difficile superinfection, drug-induced liver injury, polyneuropathy, and pulmonary toxicity

Question 10

what is second line treatment for uncomplicated UTIs?

Answer 10

one of the following beta-lactams: amoxicillin-Clavulanate or Cephalosporins

Question 11

what is the MOA of cephalosporins?

Answer 11

they disrupt bacterial cell wall synthesis

Question 12

what are the first generation cephalosporins used as a second line treatment for uncomplicated UTIs?

Answer 12

cephalexin and cefadroxil

Question 13

what are the third generation cephalosporins used for second line treatment of uncomplicated UTIs?

Answer 13

cefpodoxime and cefdinir

Question 14

what is the third-line treatment for uncomplicated UTIs?

Answer 14

fluoroquinolones: ciprofloxacin or levofloxacin

Question 15

what are the common adverse effects of fluoroquinolones:levofloxacin?

Answer 15

tendonitis and tendon rupture, CNS effects, exacerbation of myasthenia gravis

Question 16

which of the fluoroquinolones are the most potent against gram negative bacilli?

Answer 16

ciprofloxacin

Question 17

what are the indications of levofloxacin?

Answer 17

uncomplicated UTI, acute pyelonephritis, or prostatitis

Question 18

what is the first line treatment for uncomplicated pyelonephritis?

Answer 18

ciprofloxacin OR levofloxacin (so start off with fluoroquinolones right off the bat)

Question 19

if a patient has an uncomplicated pyelonephritis but resistance to fluoroquinolones, what is recommended?

Answer 19

an initial dose of ceftriaxone or aminoglycoside 24-dose

Question 20

what is an alternative first line treatment for an uncomplicated case of pyelonephritis?

Answer 20

TMP-SMX (if susceptibility is unknown, then initial dose of ceftriaxone OR aminoglycoside 24 hour dose is recommended

Question 21

what are the most common gram negative pathogens to cause complicated UTI?

Answer 21

UPEC and K. pneumoniae

Question 22

what are the most common gram positive pathogens to cause complicated UTIs?

Answer 22

enterococcus

Question 23

what is the first line treatment for patients with a complicated UTI but not requiring intensive care or suspected obstruction?

Answer 23

ceftriaxone, piperacillin-tazobactam, ciprofloxacin, OR levofloxacin

Question 24

how do you treat a patient with a complicated UTI who is at risk for MDR infection?

Answer 24

piperacillin-tazobactam, imipenem, meropenem, OR doripenem

Question 25

what should you add to a patients treatment for a complicated UTI if you suspect they may have a drug-resistant gram positive infection?

Answer 25

vancomycin, daptomycin, OR linezolid

Question 26

what is the first line treatment for patients with a complicated UTI and who require intensive care and/or suspect obstruction?

Answer 26

imipenem, meropenem, OR doripenem AND vancomycin

Question 27

how do you treat catheter associated UTI?

Answer 27

as a complicated UTI unless they are asymptomatic, then you do not treat

Question 28

how do you treat penicillin susceptible cystitis due to enterococci?

Answer 28

amoxicillin OR IV ampicillin

Question 29

how do you treat penicillin resistant cystitis due to enterococci?

Answer 29

nitrofurantoin, doxycycline, linezolid, or chloramphenicol

Question 30

how do you treat vancomycin resistant cystitis due to enterococci?

Answer 30

nitrofurantoin, doxycycline, linezolid, chloramphenicol, OR daptomycin

Question 31

how do you treat patients with candida UTI with an indwelling catheter?

Answer 31

first line: change the catheter, then if persists: fluconazole OR amphotericin B

Question 32

how do you treat patients with candida UTIs without an indwelling catheter?

Answer 32

fluconazole

Question 33

how do you treat pyelonephritis due to candida?

Answer 33

fluconazole

Question 34

when should antibiotic UTI prophylaxis be used and what is it?

Answer 34

only in women with frequently recurring UTIs (>2 in 6 months); TMP-SMX or nitrofurantoin