UTIs Flashcards
symptoms of pylonephritis v. cystitis
what bug
pylenonephritis
- dysuria
- frequency
- urgency
- hematuria
AND
- fever
- chills
- flank pain
- vomiting
Cystitis
- dysuria
- frequency
- urgency
- hematuria
- WITHOUT systemic symptoms (fever, flank pain, etc.)
Bug
- e. coli
others include….
- proteus
- klebsiella
- enterobacteriaceae
- staph. saprophyticus
Cystitis
- First Line treatments
- Second Line treatments
things to consider about treatment choices
First Line:
- nitrofurantonin X 5 days good for e. coli
- bactrum X 3 days
- fosfomycin 1 dose every 3 days
Second Line
- fluorquinolones X 3 days (cipro or levo) high e. coli resistance
- beta-lactams
consider resistance
- if loacl bactrum e. coli resistance is > 20% while avoid empiric bactrum & florquinolones
if resistance > 20% dont use theat specific medication
if florquinolones are > 10% resistance dont use
Nitrofurantonin
- duration
- pathogen coverage
- absorbtion (systemic or no)
- renal adjustment?
- long term side effects
Nitrofuratonin: first line treatment for acute uncomplicated cystitis
duration of therapy = 5 days
pathogens covered
- e. coli
- gram + and gram - coverage
absorbtion
- no systemic absorbtion – thus CANNOT be used for pyleonephritis
Reanl adjustment
- cannot be used with CrCl < 30 (BEERS list)
- CrCl < 45-60 –> decreased efficacy because it cannot be as concentrated within the urine
Long Term Side Effects (generally, short term is widely toelrated)
- neuropathy
- hepatitis
- pulmonary fiberosis
Trimethoprim-sulfamethoxazole (bactrum)
- duration
- pathogen coverage
- absorbtion
- contraindications
- resistance profile
Bactrum: first line treat of cystitic (after the use of nitrofurantonin)
duration = 3 days of thearpy
pathogens = good activity againts commony UTI bugs – but increasing resistance
resistance profile
- do not use empiric therapy if the local resistance is > 20%
Absorbtion
- can penitrate above and below the ureters – used for pyleonephritis too
Contraindications
- sulfa allergy - DO NOT USE
Fosfomycin
- duration/indications
- absorption profile
- downfalls
Fosfomycin = first line treatment (behind nitrofurantoin & bactrum) for cystitis
Duration = single dose treatment 1 dose evry 3 days
Indications = has activity against urinary resistant pathogens, including ESBLs
clinically inferior in its ability to treat cystitis compared to bactrum and nitrofurantonin
absorption
- no systemic absorption: cannot be used for pyleonephritis
expensive!!!
Fluorquinolones
- indications for use
- duration
- pathogen profile
- suceptibility profile
- side effects & warnings
Flourquinolones = last line treatment for cystitis
- ONLY ciprofloxicin and levofloxicin (moxi cannot be used– doesn’t penetrate the urine)
indications: able to penitrate both urine and upper tract – cystits and pyleonephritis can use this
duriation: 3 days of treatment
Pathogens = broad spectrum with urinary bug targets
Susceptibility
- increasing resistance profile of bugs–> due to over prescribing
Side Effects
- watch renal function
- avoid using these in uncompicated infections of UTIs –> due to QTx prolongation and CNS toxicity & c. diff
Beta lactams
- indications for cystitis
- side effects
- reasons not to use
Beta Lactams: specifically cephalosporins last ling treatment options of cystitis
- less effective & must use longer in duration
Indications
- empiritic use of cephalosporins for pyleonephritis
- naroow spectrum = lower collateral damange
Side Effects / Reasons not to use
- ESBL organisms are resistnat
- high collateral damage = c. diff, resistance, etc.
- oral cystitis treatment is less effect than bactrum or florquinolones
first line treament of cystitis in pregnant women
second? what not to use
First Line: nitrofurantoin x 5 days
Second Line:
- cephalexin x 7 days
- amoxicillin x 7 days
- amoxicillin-clavulanic acid x 7 days
avoid: fluorquinolones and bactrum
jaundice in 1sta nd 3rd trimester
Pyleonephritis
- steps to treatment
- first line thearpy
- what do you use IV
- first – get a urine culture and suceptibility profile
- start abx. while you wait for those to come back
First Line: flourquinolones or bactrium
- flourquinolones: cipro IV the PO x 7 days OR levo PO 5 days
- bactrum: 14 days PO
if pt. is vomiting –> start on IV then transition to PO
Second Line
- if FQ resistance > 10% –> use aminoglycoside or ceftriaxone
- Ceftriaxone; IV first then D/c with 10-14 days
- cannot just give oral beta lactams – need the IV dose first
what constitutes a complicated UTI
symptoms
- males
- foley catheter
- catheterization within 48 hours of a positive urine culturel
- urological structural abnormalities
- pregnancy
Symptoms
- hematuria
- flank pain
- CVA tenderness
- AMS
- new onset fever, rigors
- urinary frquency/urgency
- superpubic tenderness
Treatment of Catheter-Associated UTI/Complicated UTI
- what do you do first
- first line? second?
- duration
- non-pharm
- what must you obtain
must initiate IV antibiotics first - then can transition to oral & alter meds depending on cultures
- you must obtain urine culutres in this population – then tailor abx. treatment to the culutures to narrow thearpy
Duration: 7 days or 10-14 (if delayed response)
First Line: ceftriaxone OR **aminoglycosides (tobramycine/gentamycin) IV
Second Line
- ciprofloxicin
- levofloxicin
- bactrium
non-pharm: change the foley!!!
Treatment of Nosocomial UTI
- pathogens to cover
- First line
- second line
- duriation
Nosocominal UTI: MUST get culutre to tailor abx treatment after empiric
pathogens to cover
- e. coli (since its most common)
- PSEUODOMONAS!!
Duriation: 7 days or 10-14 if slow response
First Line (adding IV aminoglyco. if resistnace or needed)
- piperacillin-tazobactum IV + IV aminoglycoside
- Cefepime IV + IV aminoglycoside
- Ceftazidime IV + IV aminoglycoside
- Carbapenem IV (if MDR resistant)
Second Line (if PCN allergy)
- aztreonam IV + aminogly.
- ciprofloxicin IV + aminogly.
- levofloxicin + aminogly.
change the foley!!!
what if you have an ESBL prodcuting bug in the UTI
- treatment of choice
- backups to consider
Treatment of choice: Ertapenem
backups (check resistance and succeptibiltiy) consult ID if needed
- cefipime
- pip-taz.
how do you treat asymptomatic bacteruria
exceptions
YOU DONT!!: treating asymptomatic pts. leads to abx. resistance
except…
1. pregnant: must treat them with nitrofurantonin
2. urologic procedure (prior to) (do not continue afterwards unless they have a catheter placed
3. kidney transplant pt. (only have 1 working one) treatment
how do you treat a UTI in children
3rd gen cephalosporin:
- cefdinir
- cefixime
do NOT use fluorquinolones: unless the UTI is pseudomonas (because resistance and risk)
if PCN allergy: bactrium (check suseptibility)
