UTIs - treatment Flashcards
what is a-bacterial cystitis/ urethral syndrome
symptoms of a UTI but no cultures
what might abacterial cystitis/ urethral syndrome indicate
early phase of UTI, STI, urethral trauma from sexual intercourse
what management may be recommended for abacterial cystitis/ urethral syndrome
alkalising agents for urine
what is asymptomatic bacteriuria
significant bacteriuria but no symptoms
how do you manage asymptomatic bacteriuria and what is the exception
no antibiotic given - unless pregnant
why should you be careful prescribing antibiotics to catheter patients unnecessarily
catheter can become colonised with resistant organism which will cause symptoms
generally, what is prescribed for females with a lower UTI
nitrofurantoin or trimethoprim orally for 3 days
generally, what is prescribed for uncatheterised males with a lower UTI
cultures + nitrofurantoin or trimethoprim orally for 7 days
generally, what is prescribed for a complicated UTI/ pyelonephritis in a GP setting
co-amoxiclav or co-trimoxazole orally for 7 days
generally, what is prescribed for a complicated UTI/ pyelonephritis in a hospital setting
amoxicillin and gentamicin IV for 3 days
what is ESBL producing bacteria
extended spectrum beta-lactamase - enzymes produced by certain bacteria that can be found in the bowel
what antibiotics are ESBL producing bacteria resistant too
cephalosporins and almost all penicillins
what antibiotics can be used for ESBL producing bacteria
nitrofurantioin, pivmecillinam, IV temocillin, IV ertapenem
what is CPE and what gram are they
carbapenemase producing enterobacteriacaece gram -ive coliform
what antibiotics are CPE resistant too
all antibiotics
what are the first line antibiotics for UTIs
amoxicillin (IV or oral), trimpethroprim (IV cotrimoxazole), nitrofuranotoin (oral), gent (IV)
what are the second line antibiotics for UTI’s
pivmecillinam (oral), temocillin (IV), cefalexin (oral), co-amoxiclav, ciprofloxacin
when would 2nd line ab’s be used
if resistant organisms
how does trimethoprim work
inhibits nucleic acid synthesis by inhibiting folic acid synthesis
what organisms does trimethoprim work against
most coliforms eg E.coli, staph A (including MRSA)
what organisms are resistant to trimethoprim
pseudomonas
when should trimethoprim not be prescribed
first trimester of pregnancy
why can nitrofurantoin only be used in UTI’s and not pyelonephritis
effective concentration only reached in bladder so ineffective in kidneys
what organisms does nitrofurantoin work against
most coliforms eg E.coli, enterococci, MRSA, staph A
what organisms does nitrofurantoin not work against
proteus or pseudomonas
when should nitrofurantoin not be prescribed
late pregnancy, breast feeding, children <3 months - can cause neonatal haemolysis
what organism is amoxillin used to treat for UTI’s
enterococcus faecalis - only use once cultures are done
why is gentamicin dangerous
narrow therapeutic index
what dangerous side effects can gentamicin cause
renal damage or CN VIII nerve damage
what organisms is IV gent used for
(gram -ive coliforms) coliforms, pseudomonas, staph A
what drug class does pivmecillinam belong too and how does it work
penicillin - inhibits cell wall synthesis
what organisms is pivmecillinam given for
ESBL’s - gram -ive coliforms
what organisms are resistant to pivmecillinam
staph, enterococci and pseudomonas
what is used in patients who cannot tolerate gentamicin eg kidney failure
IV temocillin (penicillin)
what drug class is cefalexin and how does it work
oral cephalosporin - inhibits cell wall synthesis
when is cefalexin used
if resistant to amoxicillin and trimethoprim
what organisms is cefalexin used for
coliforms and staph A (not MRSA)
what is co-amoxiclav a combination of
amoxicillin and clavulanic acid
what organisms are co-amoxiclav used for
coliforms, enterococci, staph A (not MRSA)
what type of antibiotics are carbapenems
cell wall synthesis inhibitors (beta lactams)
name 3 carbapenems
meropenem, ertapenem, imipenem
what are carbapenems used to treat
pseudomonas
what antibiotics are used to treat MRSA
tetracycline (eg doxy) or daptomycin
