Flashcards in Treatment of GU infections Deck (33):
What organism should be targeted in cystitis?
E. coli, with hopes of covering other gram negatives, and S. saprophyticus
What are the first line treatments which need 3, 5, and 7 days of therapy?
3 days: TMP / SMX, and FQ (Levofloxacin and Ciprofloxacin only)
5 days: Nitrofurantoin
7 days: Beta-lactams - i.e. Cephalexin
How long is an antibiotics course for S. saprophyticus?
What is the mechanism of action of Fosfomycin?
Inhibits (fosfo)enolpyruvate transferase which inhibits cell wall synthesis
What is the practical clinical use of fosfomycin?
Given for cystitis / lower UTI infections with drug-resistant isolates, which is safe to use in pregnancy
What are the first line treatments for community-acquired pyelonephritis, given orally? Duration of therapy?
FQ (i.e. Cipro)
3rd generation Cephalosporin
Generally 7-14 days of therapy is fine, leaning towards 7
What two drugs used to treat lower UTIs cannot be used in pyelonephritis and why?
Nitrofurantoin / fosfomycin -> do not reach sufficient levels in the kidney tubules
What are the first line drugs for pyelonephritis UTI's when hospitalization occurs?
Fluoroquinolones, aminoglycosides, 3rd generation cephalosporins, carbapenems (not empirically)
transition to oral therapy to complete course
What is the most common way to get a healthcare associated UTI and what organism must you cover?
From a Foley Catheter
Must cover P. aeruginosa
What are the drugs of choice for healthcare associated UTI?
Cefepime or ceftazidime
Cipro / Levo
Carbapenems minus ertapenem
What two conditions absolutely need the treatment of asymptomatic bacteriuria?
2. Urinary tract surgery / instrumentation
Neonates / renal transplant are less clear
How do you treat candiduria?
You don't. Just discontinue Foley catheter and discontinue unnecessary antibiotics
What organism causes chancroid and how is it treated?
Azithromycin 1 g PO, 1 dose
Counts a 7 day course. Same treatment as Chlamydia.
Who else should be treated in the case of chancroid?
Anyone making sexual contact within 10 days of the partner's symptoms
What is the treatment for first episode of HSV-2 genital herpes?
Valacyclovir twice daily x7-10 days.
What is suppressive therapy for HSV-2?
Reduces frequency of HSV breakouts, best for patients with frequent (>6) per year.
Once daily Valacyclovir or 2x acyclovir
What do you do if HSV-2 recurs?
5 day course of acyclovir / valacyclovir
What is the treatment for severe disseminated HSV causing encephalitis or other major complications?
IV acyclovir x 2-7 days until improvement, oral therapy to complete a 10 day course
What is the treatment for primary / secondary syphilis? What do you do if the patient has an allergy?
Benzathine penicillin G, 2.4 million units IM x1
If patient has allergy: desensitize. Doxycycline, ceftriaxone, and azithromycin are way less effective
What are the treatments for latent and tertiary syphilis?
3 doses of Benzathine penicillin G, 2.4 million units IM, separated by 1 week
What is the treatment for neurosyphilis (CNS involvement)?
24 million units of IV aqueous penicillin G x10-14 days
Literally 10x the dose
What is the Jarisch-Herxheimer reaction? How is it treated?
Headache, myalgias, fever, and tachycardia occurring 1-2 hours after starting treatment of syphilis due to release of pyrogen from spirochetes, can last 1-2 days.
Treated via anti-inflammatories
What is the treatment for Chlamydia trachomatis?
Azithromycin 1g PO x 1 dose
or (macrolide allergy)
Doxycycline 100 mg PO x 7 days
What should be done for sexual partners exposed to Chlamydia-infected person?
If within 60 days of symptoms, come for ID consult (was 10 days for chancroid)
What organism should be considered for non-gonoccal urethritis if doxycycline was given?
A second, less likely cause of non-gonococcal urethritis.
Treat with moxifloxacin (assuming they had doxy due to azithromycin allergy)
What are two uncomplicated gonococcal infections and what is the treatment?
Treatment: Ceftriaxone 250 mg IM x 1
Azithromycin 1g PO x 1 dose (always treat for chlamydia)
What can be given for gonococcal infection if the patient has a cephalosporin allergy?
What are the treatments for bacterial and fungal vaginosis?
Bacterial: Gardnerella - Metronidazole x 7 days
Fungal: Fluconazole x 1 dose
What is the treatment for trichomonas vaginalis?
Metronidazole in a 2g x 1 dose
Or 500 mg bid x 7 days (same as Gardnerella)
What are the organisms causing PID?
1. N. gonorrhea
2. C. trachomatis
3. gram negatives and anaerobes
What is the empiric regimen for PID?
Cefoxitin to cover gonorrhea
Doxycycline to cover chlamydia
BOTH GIVEN IV until there is a response
What are the most likely causative organisms of epididymitis?
C. trachomatis / N. gonorrhea
If anal intercourse: GI flora i.e. E. coli or P. aeruginosa