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PHARM3 > UTI tx-Table 1 > Flashcards

UTI tx-Table 1 Flashcards

1
Q

What is a UTI?

A

Presence of bacteria/yeast in uncontaminated urine

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2
Q

What is “significant” bacteriuria?

A

> 100,000/mL; can be lower in certain situations (abx, sx, complicated UTIs)

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3
Q

What differentiates complicated from uncomplicated UTI?

A

Complicated: presence of urinary tract abnormalities (males, pH, tumors, congenital, stones, catheter, reflux, retention, neuropathies)

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4
Q

What is reinfection vs relapse?

A
  • Reinfection: new organism (majority of UTI’s)

* Relapse: same organism

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5
Q

What host factors affect UTIs?

A

•Gender differences
urethral length, moisture, estrogen, lactobacilli
•Mechanical - Diuresis
•Environmental
pH, osmolality, urea, organic acids
•Specific antibacterial substances
IgG, IgA (present in upper UTI)
Tamm-Horsfall protein (ascending loop)
Glycosaminoglycan (bladder)
Prostatic fluid

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6
Q

What are risk factors for UTI?

A 
•Congenital abnormalities (UTIs in children)
•Incomplete voiding
•Urinary catheters
•Sexual activity (esp. in young women)
      Spermicide use
•Decreased host defenses
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7
Q

What organisms can cause UTI?

A
  • E. coli
  • Enterococcus spp.
  • Klebsiella spp.
  • Proteus spp.
  • Enterobacter spp.
  • Pseudomonas aeruginosa
  • Staphylococcus aureus
  • Coagulase negative staphylococcus
  • Group B streptococci
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8
Q

What are symptoms of lower UTI?

A

Urgency, dysuria, frequency, nocturia, suprapubic tenderness/pain/heaviness, gross hematuria

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9
Q

What are symptoms of an upper UTI?

A

Lower tract symptoms, fever, +/- chills, flank pain, N/V

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10
Q

What are some pts that present atypically with UTI? How do they present clinically?

A

•Children

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11
Q

How is UTI diagnosed?

A

UA and culture

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12
Q

What indicates pyelonephritis?

A

hyaline or leukocyte casts

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13
Q

How are UTI tx?

A

•Acidification
Cranberry juice
Nitrofurantoin works better in acid environment
•Analgesics
Phenazopyridine (Pyridium)
100-200 mg PO TID after mealsx2days w/ABX
Avoid use if CrCl

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14
Q

What can increase the amount of drug needed to tx UTI?

A

Cation concentration- High concentration of Mg or Ca can increase aminoglycoside MIC against Gram-negative bacteria

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15
Q

What are the basics of acute uncomplicated UTI tx?

A
  • Single dose regimens not recommended
  • Initial urine culture not necessary
  • If patient fails 3-day course then culture and treat for 2 weeks
  • 7-day course recommended in pregnancy
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16
Q

What is the tx for an acute uncomplicated UTI with e coli resistance to TMP/SMX

A

TMP/SMX DS 1 PO BID x 3 days

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17
Q

What are alternative tx for pts with sulfa allergy?

A
  • Nitrofurantoin (Macrodantin) 100 mg PO q6h X 5 days

* Fosfomycin 3 g powder as single dose

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18
Q

What is the tx for an acute uncomplicated UTI with e coli resistance to TMP/SMZ >20%?

A
  • Ciprofloxacin (Cipro) 250 mg PO BID X 3 days
  • Cipro ER 500 mg PO daily X 3 days
  • Levofloxacin (Levaquin) 250 mg PO daily X 3 days
  • Amoxicillin/Clavulanate 875/125mg BID X 5-7 days or an oral Cephalosporin (Cephalexin 500mg QID x 5-7 days)
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19
Q

Which of the above meds should be reserved for cases when other agents cannot be used?

A

The beta lactams- these are usually less efficacious and we want to avoid resistance

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20
Q

What meds should not be used to tx UTI?

A

gemifloxacin (Factive) or moxifloxacin (Avelox)

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21
Q

What is the typical pt presentation of acute uncomplicated pyelonephritis?

A

women 18-40 y.o, T>102°F, CVA tenderness

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22
Q

If you have an outpt (mild-moderately ill) pt with pyelo, what is your first line tx?

A

FQ PO X 7 days
•Ciprofloxacin 500 mg 1 PO BID, or Cipro ER 1000 mg 1 PO daily for 5-7 days
•Levofloxacin 750 mg 1 PO daily or Ofloxacin 400mg BID for 5-7 days

23
Q

What should be your first line for uncomplicated outpt pyelo if there is FQ resistance?

A

Ceftriaxone 1gm or 5-7 mg/kg Gentamicin or tobramycin (if normal renal function) as one time dose

24
Q

What are alternative tx for uncomplicated outpt pyelo?

A

14 days of…..
•Amoxicillin/clavulanate (Augmentin) 500/125 mg PO TID or 875/125 mg PO BID
•Cephalexin (Keflex) 500 mg PO QID- or other oral cephalosporin
•If an oral cephalosporin is used administer Ceftriaxone 1gm or 5-7mg/kg Gent or tobra as a one time dose
•TMP/SMX DS PO BID

25
Q

How is uncomplicated pyelo in hospitalized pts tx?

A

IV until pt afebrile 24-48 hrs then PO to complete 14 days

26
Q

What are the 1st line tx options for acute uncomplicated pyelo in a hospitalized pt?

A

FQ IV
•Ciprofloxacin 400 mg IV q12h
•Levofloxacin 750 mg IV daily
Ampicillin 2 g IV Q6H + gentamicin 5 mg/kg IV Q24H
Ceftriaxone (Rocephin) 1-2 g IV q24h
Piperacillin/tazobactam 3.375 g IV q8h ext inf over 4 h

27
Q

What are alternative tx for the above pt?

A
  • Piperacillin/tazobactam (Zosyn) 3.375 g IV q6h or 4.5 g IV q8h
  • Ampicillin/sulbactam (Unasyn) 3 g IV q6h
  • Ertapenem (Invanz) 1 g IV q24h
28
Q

What constitutes a complicated UTI?

A

Obstruction, reflux, azotemia, transplant, male

29
Q

How long should complicated UTI be tx?

A

2-3 weeks

30
Q

How should the tx be administered in complicated UTI?

A

IV- switch to PO when afebrile for 24-48 hours

31
Q

What are the 1st line tx options for complicated UTI ?

A
  • Amp 2 g IV Q6H + gentamicin 5 mg/kg IV Q24H
  • Pip/tazo 3.375 IV Q8h ext infusion
  • Imipenem/cilastatin (Primaxin) 500 mg IV Q12H
  • Meropenem 1gm IV q 8h
32
Q

What are alternative tx for complicated UTI?

A
  • Ciprofloxacin 400 mg IV Q12H
  • Levofloxacin 750 mg IV daily (FDA approved for 5 days)
  • Ceftazidime 2gm IV q 8h
  • Cefepime 2gm IV q 12h
33
Q

What should you switch to for PO tx of complicated UTI?

A

Fluoroquinolones (Cipro-ER 1000 mg PO QD, Levo 500 mg PO QD) or TMP/SMX DS 1 PO BID

34
Q

How should recurrent UTI be tx?

A

Tx the uncomplicated UTI, then try one of the following options if they have >/= 3 UTI/yr
•Patient-initiated therapy: TMP/SMX DS 2 tabs at onset sx
•Postcoital prophylaxis: TMP/SMX DS 1 tab PO postcoitus or single dose nitrofurantion 100mg postcoitus- if you are sarah M this could be up to 20x a day ;)
•Continuous prophylaxis: TMP/SMX SS 1 PO QDay long term

35
Q

Is screening and tx for asymptomatic bacteriuria recommended in most pts?

A

NO

36
Q

When should you screen for bacteriuria in pregnancy?

A

1st trimester then periodically

37
Q

Why should you screen in pregnancy?

A
  • 20-30-fold increase in rate of pyelonephritis

* Increased risk of premature delivery and low birth weight

38
Q

How long should you tx asymptomatic bacteriuria in preggos?

A

Treat for 3-7 days
•Amoxicillin/clavulanate (Augmentin) 875/125 mg PO BID
•Nitrofurantoin (Macrodantin) 100 mg PO QID
•Cephalexin (Keflex) 500 mg PO QID
•TMP/SMX (Bactrim) DS 1 PO BID (avoid within 2 weeks of delivery)

39
Q

What is urethral syndrome?

A

UTI symptoms without significant bacteriuria

40
Q

How common is urethral syndrome?

A

40% of young women have this

41
Q

What are the common organisms that cause urethral syndrome?

A

Chlamydia trachomatis, N. gonorrhoeae, G. vaginalis, U. urealyticum, and chemical irritation also possible

42
Q

What is the tx for urethral syndrome?

A

Standard tx for uncomplicated UTI
If gonococcal: Ceftriaxone 250mg IM X 1 dose + Azith 1gm po x 1 dose or Doxycycline 100mg po q 12h X 7 days

If non-gonococcal and symptoms persist: Metronidazole 2gm po single dose or azithromycin (1 gm X 1)

43
Q

What are the causative organisms in short-term cath (

A

•Yeast (~32%)
•E. coli (12-29%)
Coag-negative Staph (23-26%)

44
Q

What are the causative organisms in long-term cath (>30 days) associated UTIs?

A

•Proteus Mirabilis (10-60%)
•Providencia spp.(~50%)
•Pseudomonas (10-60%)
E. coli (18-35%)

45
Q

How do you tx nosocomial/catheter associated UTI?

A

Tx for 7 days if prompt resolution of symptoms and 10-14 days if delayed response
Start with IV then switch to PO as symptoms/course allows

46
Q

If a pt

A

•N. gonorrhoeae, C. trachomatis

tx for 10days

47
Q

What should you tx the above pt with?

A
  • Risk STD: Ceftriaxone 250 IM X1 dose or cefixime 400mg po x 1 dose + doxycycline 100 mg PO BID x 10days
  • Low risk STD- as below Cipro or levofloxacin or TMP-SMX
48
Q

If a pt >35 presents with prostatitis, what organism should you suspect and how long should you tx/

A

•Enterobacteriaceae

tx for 10-14 days

49
Q

What meds should you tx the above pt with?

A
  • Cipro ER 500 mg PO BID or 400 mg IV BID
  • Levofloxacin 500-750 mg IV/PO Qday
  • TMP/SMX DS 1 PO BID
50
Q

If there is resistant enterobacteriaceae in the above pt what can you use to tx instead?

A

Ertapenem 1gm IV q day for at least 2 weeks (may continue for up to 4 weeks)

51
Q

If there is resistant pseudomonas in the above pt what can you use to tx instead?

A

Imipenem/ cilastin 500mg IV q 6h or meropenem 500mg IV q 8h for 4 weeks

52
Q

What are the main organisms in chronic prostatitis?

A

Enterobacteriaceae 80%, enterococci 15%, P.aeruginosa

53
Q

How is chronic prostatitis tx?

A
  • Ciprofloxacin 500 mg PO BID X 4 wks
  • Levofloxacin 500 mg PO QD X 4 wks
  • TMP/SMX DS 1 PO BID X 1-3 months

PHARM3 (16 decks)

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