Management of UTI

Question 1

What are the types of genitourinary infections?

Answer 1

Urethritis, cystitis, pyelonephritis, prostatitis, epididymitis.

Question 2

What patient factors make a UTI complicated?

Answer 2

Male sex, pregnancy, structural abnormalities, immunocompromised, urologic procedures, catheter use.

Question 3

What are the most common pathogens in uncomplicated UTIs?

Answer 3

Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, Staphylococcus saprophyticus.

Question 4

What are the common pathogens in complicated UTIs and catheter-associated infections?

Answer 4

E. coli, Proteus, Klebsiella, Enterococcus, Pseudomonas, other enteric Gram-negatives.

Question 5

What are hallmark symptoms of cystitis?

Answer 5

Dysuria, urinary urgency, frequency, suprapubic pain.

Question 6

What symptoms distinguish pyelonephritis?

Answer 6

Fever, chills, nausea, vomiting, CVA tenderness.

Question 7

What urinalysis findings support UTI diagnosis?

Answer 7

Positive leukocyte esterase, nitrites, WBC ≥10/hpf, and bacteria.

Question 8

How is UTI confirmed via urine culture?

Answer 8

≥10^5 CFU/mL in clean-catch or ≥10^3 CFU/mL in catheter sample.

Question 9

When should asymptomatic bacteriuria be treated?

Answer 9

Only in pregnancy or prior to urologic procedures with expected mucosal bleeding.

Question 10

Why should ASB generally not be treated?

Answer 10

Overtreatment increases antimicrobial resistance and causes unnecessary adverse effects.

Question 11

What oral agents are used for uncomplicated UTI?

Answer 11

Nitrofurantoin, TMP-SMX, fosfomycin, beta-lactams, fluoroquinolones (if needed).

Question 12

Which UTI agents should only be used if susceptibility confirmed?

Answer 12

Amoxicillin, due to high resistance.

Question 13

What is the first-line therapy duration for nitrofurantoin in uncomplicated UTI?

Answer 13

5 days.

Question 14

What IV agents are used for empiric treatment of complicated UTI?

Answer 14

Ampicillin + gentamicin, ceftriaxone, cefepime, gentamicin monotherapy (based on local susceptibilities).

Question 15

What is the typical duration of therapy for complicated UTI?

Answer 15

7–14 days depending on severity and response.

Question 16

What antibiotics are preferred for bacterial prostatitis?

Answer 16

Fluoroquinolones, TMP-SMX, possibly beta-lactams (e.g., cephalexin, amoxicillin/clavulanate).

Question 17

Why must prostate penetration be considered in prostatitis treatment?

Answer 17

Prostate lacks active transport; drug must be lipid-soluble and unbound for penetration.

Question 18

What defines a recurrent UTI?

Answer 18

≥3 infections in 1 year or ≥2 in 6 months.

Question 19

What are common causes of recurrent UTIs?

Answer 19

Sexual activity, postmenopausal changes, urologic abnormalities.

Question 20

What is a prophylaxis strategy for recurrent UTI when no modifiable risk is found?

Answer 20

Use narrow-spectrum prophylactic antibiotics (e.g., low-dose nitrofurantoin, TMP-SMX).

Question 21

What is the first-line antibiotic for uncomplicated cystitis?

Answer 21

Nitrofurantoin 100 mg BID for 5 days.

Question 22

What is the alternative to nitrofurantoin for uncomplicated UTI?

Answer 22

TMP-SMX DS BID for 3 days (if local resistance <20%).

Question 23

When is fosfomycin appropriate for UTI?

Answer 23

As single-dose therapy (3 g x 1) for uncomplicated cystitis; especially if resistance is a concern.

Question 24

Why is amoxicillin not first-line for uncomplicated UTI?

Answer 24

High resistance rates; only use if susceptibility known.

Question 25

What are empiric antibiotics for inpatient complicated UTI or pyelonephritis?

Answer 25

Ceftriaxone, cefepime, gentamicin, or ampicillin + gentamicin.

Question 26

What oral agents can be used for step-down therapy in pyelonephritis?

Answer 26

Ciprofloxacin, levofloxacin, TMP-SMX (if susceptible).

Question 27

When should IV to PO switch be considered in complicated UTI?

Answer 27

After 48–72 hours of clinical improvement and known susceptibilities.

Question 28

What antibiotics are preferred for acute prostatitis?

Answer 28

Fluoroquinolones (e.g., ciprofloxacin, levofloxacin) or TMP-SMX.

Question 29

What is the typical duration of therapy for prostatitis?

Answer 29

2–4 weeks for acute, 4–6 weeks for chronic.

Question 30

What is the antibiotic of choice for UTI in pregnancy?

Answer 30

Amoxicillin-clavulanate, cephalexin, or nitrofurantoin (not in 3rd trimester).

Question 31

What antibiotics should be avoided in pregnancy for UTI?

Answer 31

Fluoroquinolones and TMP-SMX (especially in 1st and 3rd trimester).

Question 32

What is the empiric treatment approach for CAUTI?

Answer 32

Based on local antibiogram; common options include cefepime, piperacillin-tazobactam, carbapenems if MDR suspected.

Question 33

When should catheter removal or replacement be considered in CAUTI?

Answer 33

Before starting antibiotics to reduce bacterial burden and resistance risk.

Question 34

What criteria help determine if a UTI is complicated?

Answer 34

Male sex, pregnancy, anatomical abnormality, immunocompromised, catheter use, recent urologic procedures.

Question 35

What is the preferred empiric therapy for uncomplicated cystitis?

Answer 35

Nitrofurantoin 100 mg BID x 5 days, TMP-SMX DS BID x 3 days, or fosfomycin 3 g once.

Question 36

When should nitrofurantoin be avoided?

Answer 36

If creatinine clearance <30 mL/min or for pyelonephritis (inadequate tissue levels).

Question 37

When should fluoroquinolones be used for UTI?

Answer 37

Reserved for pyelonephritis or complicated UTI when other options are not suitable.

Question 38

Which antibiotics are safe for use in pregnancy for UTI?

Answer 38

Amoxicillin-clavulanate, cephalexin, nitrofurantoin (avoid in 3rd trimester), fosfomycin.

Question 39

Why is amoxicillin alone not recommended for UTI?

Answer 39

High rates of E. coli resistance; use only if susceptibility is known.

Question 40

What defines asymptomatic bacteriuria and when should it be treated?

Answer 40

Presence of bacteria in urine without symptoms; treat only in pregnancy or before urologic procedures.

Question 41

What are symptoms that distinguish pyelonephritis from cystitis?

Answer 41

Systemic signs: fever, chills, flank pain, nausea, vomiting, CVA tenderness.

Question 42

What are key counseling points for nitrofurantoin?

Answer 42

Take with food, may cause brown urine, avoid in late pregnancy or poor renal function.