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Flashcards in 22 - Treatment of UTI Deck (60)
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1

Which of the following agents inhibits DNA synthesis?

- Ciprofloxacin
- Levofloxacin
- Fosfomycin
- Trimethoprim/ sulfamethaxazole
- Nitrofurantoin

Trimethoprim/sulfamethaxazole

2

Which of the following agents inhibits cell wall synthesis?

- Ciprofloxacin
- Levofloxacin
- Fosfomycin
- Trimethoprim/ sulfamethaxazole
- Nitrofurantoin

Fosfomycin

NOT a beta-lactam though

3

Which of the following agents inhibits DNA gyrase and topoisomerase?

- Ciprofloxacin
- Levofloxacin
- Fosfomycin
- Trimethoprim/ sulfamethaxazole
- Nitrofurantoin

- Ciprofloxacin
- Levofloxacin

4

Which bacteria are most often associated with uncomplicated urinary tract infections?

E coli

5

What is the second most common cause of uncomplicated UTIs?

Other gram negatives

6

Which is NOT a first line agent for the treatment of uncomplicated UTI?

- Nitrofurantoin
- TMP-SMX
- Fosfomycin
- Ciprofloxacin

Ciprofloxacin

First line
- Nitrofurantoin
- TMP-SMX
- Fosfomycin

7

What are some important predisposing factors for the development of a UTI?

Female anatomy
- Short urethral distance
- Acquisition of gut flora
- Chronic vaginal colonization seeds urethra
- Sexual intercourse displaces bacteria into the bladder

Bottom line - just being female is a predisposing risk factor

8

What other factors can result in a UTI?

- Structural abnormalities
- Obstruction/disruption of urine flow
- Instrumentation (catheter)

9

Describe the types of structural abnormalities which result in UTI

- Congenital malformation
- Vesicoureteral reflux

10

Describe the types of obstruciton/disruption in urine flow which results in UTI?

- Renal calculi (kidney stones)
- Tumors
- Neurologic problems
- Pregnancy
- Prostatic hypertrophy

11

Describe catheterization as a predisposing risk factor for UTI

- Disrupts normal protective function of the bladder
- Introduction of bacteria
- Contamination of the catheter drainage system
- Duration of catheterization (risk increases by 3-5% each day of catheterization)

**** KNOW that the duration of catheterization is important ****

12

What factors of the BACTERIA aid in the development of a UTI?

- Pili or Fimbriae
- Urease
- Hemolysins
- Capsule

13

How does pilli or fimbriae aid bacteria in UTI?

Consists of pilins and adhesins that can facilitate attachment to host cells

14

How does urease aid bacteria in UTI?

Create a buffered microenvironment

15

How does hemolysins aid bacteria in UTI?

Toxin that disrupts eukaryotic cell membranes and causes cell lysins

16

How does a capsule aid bacteria in UTI?

Polysaccharide structure that prevents phagocytes from engulfing bacteria

17

What are common manifestations of UTI?

- Cystitis
- Pyelonephritis

18

What is cystitis?

Bladder or lower urinary tract infection

19

What are the symptoms of cystitis?

dysuria (painful urination)
increased frequency of urination
feeling of urgency
WBC’s & bacteria in urine
hematuria (possible)

**fever is usually absent

20

What is pyelonephritis?

Kidney or upper urinary tract infection

21

What are the symptoms of pyelonephritis?

flank pain*
fever*

dysuria (painful urination)
increased frequency of urination
feeling of urgency
WBC’s & bacteria in urine
hematuria (possible)

22

What is the difference between complicated and uncomplicated cystitis?

Uncomplicated
- Healthy, ambulatory, no abnormalities
- Mild cystitis to severe pyelonephritis
- No predisposing factors
- First line short course of antimicrobial regimen (5-14 days - SHORTER)

Complicated
- Diabetes
- Impaired sensation
- Stone or obstruction
- 7 day or longer course of fluoroquinolone preferred
- 14-21 day duration recommended in general (LONGER)
- Not going to focus on these treatment options (more aggressive)

23

Describe the classification systems for uncomplicated and complicated

NOTE: Current classification schemes are overly simplistic, especially for patients with complicated infections, but the value of more complex classification schemes has not yet been shown

24

What drugs are the first line agents for uncomplicated cystitis?

- Nitrofurantoin
- TMP-SMX
- Fosfomycin

25

What are ecological effects?

- You're getting collateral damage
- You promote the growth of resistant bacteria
- Knock down normal microbiota

26

Describe the type and MOA of nitrofurantoin

- Synthetic nitrofuran, antiseptic drug
- MOA: Bacterial reduction of compound to generate DNA damaging intermediates

27

Describe the efficacy and clinical consideration of nitrofurantoin

- 93% (84-95%)
- Few ecological effects, nausea, diarrhea, headache, flatulence

28

Describe the type and MOA of TMP-SMX

- Diaminopyrimidine +sulfonamide
- MOA: Disrupt folate metabolism

29

Describe the efficacy and clinical consideration of TMP-SMX

- 93% (90-100%)
- Few ecological effects, folate concerns if there is a deficiency, dermatological rxns (photosensitivity), rash

30

Describe the type and MOA of fosfomycin

- “Other cell wall inhibitors”
- MOA: Cell wall synthesis inhibitor