Treatment of UTIs, C. diff, STIs, and Tickborne Diseases Flashcards
(24 cards)
UTIs: OW
Acute cystitis
-Uncomplicated LOWER UTI
Pyelonephritis
-UPPER UTIs in the KIDNEYS
UTIs more common in females
-In males, UTIs due to abnormality or obstruction (enlarged prostate, indwelling catheter, kidney stone, neurogenic bladder of SCI/stroke/MS)
UTIs: SX/LABS
Cystitis (Lower UTI)
-Urgency and frequency (+ nocturia)
-Dysuria (painful urination/burning)
-Suprapubic tenderness
-Hematuria (blood in the urine)
Pyelonephritis (Upper UTI)
-Flank/costovertebral angle pain
-Abdominal pain, NV
-Fever, chills, malaise
Urinanalysis
-Pyuria (WBC 10+)
-Positive leukocyte esterase/nitrites
-Bacteria
Acute Cystitis: TX
E. coli (main) (CYS sis that’s My BF QAC)
- Macrobid (nitrofurantoin) 100 mg BID x 5 days
-CI: CrCl <60 - Bactrim 1 DS BID x 3 days
-CI: sulfa allergy or 20%+ E. coli res - Fosfomycin 3 g x 1 dose
Alternatives
-Augmentin or cepha x 5-7 days
-Cipro BID or Levo QD (250) x 3 days
UTIs In Pregnancy + Duration
-Amoxicillin
-Cephalexin
-Fosfomycin (if BL allergy)
Only if other options not available (fetal risk)
-Bactrim
-Macrobid
ABC MF
Duration: 7 days
UTI: PPX
If ≥ 3 episodes in 1 year
-Bactrim SS 1 tablet QD
-Macrobid 50 mg PO QD
-Bactrim DS 1 tablet after sex
Acute Pyelonephritis: Outpatient TX
If local Q resistance < 10%
-Cipro 500 BID x 5-7d
-Levo 750 QD x 5-7d
If local Q resistance > 10%
-CTX 1 g x 1
-Erta 1 g x 1
-AG (extended interval dose) x 1 then continue with a Quinolone as above
*Concern for Quinolone AE
-Bactrim x 7-10d
-BL (augmentin, cefdinir, cefadroxil, cefpodoxime) x 7-10d
PIE Question about your ETA BB
Acute Pyelonephritis: Inpatient TX
Initial:
-CTX or Quinolone (CL)
Resistance:
-Zosyn
-Carbapenem (if ESBL)
Step down to oral tx options based on cx/sus
Duration: 5-10 days
Urinary Analgesic
Phenazopyridine (AZO, Pyridium)
-Helps with dysuria (does not tx inf)
-OTC and Rx
200 mg PO TID x 2 days MAX
-Take with 8 oz water and food
CI: renal impairment or liver disease
AE: can cause red-orange urine/bf (can stain contact lenses/clothes)
-Hemolytic anemia with G6PD def
LOKA WTF
Asymptomatic Bacteriuria In Pregnancy
≥ 10^5 bacteria/mL on a urinalysis
MUST be treated in pregnancy
BL preferred
-Augmentin
-Oral cephalosporin
Alternatives
-Macrobid, Bactrim, Fosfomycin (in BL allergy, last line)
(Macrobid avoid in 3rd trimester = hemolytic anemia in infant)
(Bactrim avoid in 1st trimester = HBR and kern in neonates)
AVOID QUINOLONES
C. difficile Tx
1st episode
-FDX 200 mg BID x 10d
-VANCO 125 mg QID x 10d
-MET 500 mg TID x 10d (only if non-sev and options above not available)
2nd episode (1st recurrence)
-FDX 200 mg BID x 10d
-VANCO 125 mg QID x 10d followed by tapered course (standard VANCO regimen can be used if MET was used in initial episode)
3rd episode (or subsequent episodes)
-FDX 200 mg BID x 10d
-VANCO 125 mg QID x 10d followed by tapered course
-VANCO 125 mg QID x 10d followed by Rifaximin 400 mg TID x 20d
-Fecal microbiota transplantation
Bezlotoxumab (Zinplava)
Binds to toxin B and neutralizes it
Shown to decrease CDI recurrence but does NOT TREAT active CDI
-Must be given with abx tx
Adjunct considered in high risk
-65+ yr
-IC
-Severe presentation
-CDI hx within 6 mo
C. difficile Fulminant/Complicated TX
Dx when significant systemic toxic effects are present
-hypotension, shock, ileus or toxic megacolon
Tx
-VANCO 500 mg PO/NG/PR QID + metronidazole 500 mg IV TID
Common STI Sx
Chlamydia/Gonorrhea
-genital discharge or no symptoms
Genital warts
-single/multiple pink/skin-toned lesions
Latent syphilis
-asymptomatic
Primary syphilis
-painless, smooth genital sores (chancre)
Females
-BV: discharge, fishy, pH 4.5+, little/no pain
-Trich: yellow/green, FROTHY discharge, pH 4.5+, pain with intercourse, sore
Syphillis: TX
+ RPR or VDRL, treponemal assay
Primary, Secondary, Early Latent
-PCN G benzathine (Bicillin-LA) 2.4 MU IM x 1
Alternatives (BL allergy)
-Doxycyline 100 mg BID x 14 d
-If pregnant: de-sensitize
Late Latent (1+ yr ago/unknown with no sx) or Tertiary
-As above except 2.4 MU IM weekly for 3 weeks (7.2 MU total)
-Alt: Doxy 100 mg BID x 28 d
Neurosyphillis: TX
DOC
-Penicillin G aqueous crystalline 3-4 MU IV Q4 x 10-14 d
Alt
-Penicillin G procaine
BL allergy
-Desensitization followed by penicillin G aqueous
Gonorrhea: TX
CEFTRIAXONE
- < 150 kg: 500 mg IM x 1
- 150+ kg: 1000 mg IM x 1
*If chlamydia has not been excluded: add doxycycline
Same tx for pregnancy
If ctx is not available:
-Cefixime 800 mg PO x 1
If cephalosporin allergy:
-Gentamicin 240 mg IM x 1 + azithromycin 2 grams PO x 1
-Consult ID specialist
3 fat FAGs have GONO
Chlamydia: TX
Non-pregnant
-Doxycycline 100 mg BID x 7d
Pregnant
-Azithromycin 1 g PO x 1
Alt
-Erythromycin base 500 mg QID x 7d
-Levofloxacin 500 mg QD x 7 days
-Pregnancy: AMOX 500 mg TID x 7 d
clammy is DA PALE
Bacterial Vaginosis: TX
-Metronidazole 500 mg BID x7d
or
-Metronidazole 0.75% gel QD x5d
or
-Clindamycin 2% cream QD x7d
Alt
-Clindamycin PO/vaginally
-Tinidazole
-Secnidazole
Trichomoniasis: TX
Metronidazole
-Females: 500 mg BID x7d
-Males: 2 g x 1
Pregnancy:
-MET CI in 1st trimester but CDC recs MET in all trimesters
Genital Warts: TX
Imiquimod cream (Zyclara)
-Apply to warty tissue and wash off in 6-10 hours
-Apply 3x a week until cleared (or 16 weeks max)
Abstain from sex while cream is on skin (can weaken condoms and irritate etc)
Syphilis De-sensitization
In pregnancy and poor compliance
Per CDC
-Confirm allergy with skin test
-Desensitize pt with approved protocol
-Treat with IM PCN G benzathine
Rocky Mtn Spotted Fever: TX
Most common/fatal
-Erythematous petechial rash (pinpoint or splotchy red spots)
Doxycycline 100 mg PO/IV BID x 5-7 d
-DOC including for pediatric pts
Lyme Disease: TX
Doxycycline 100 mg PO BID x 10 days
or
Amoxicillin 500 mg PO TID x 14 days
or
Cefuroxime 500 mg PO BID x 14 days
Sx: BULLSEYE RASH (LIME XXX DOX AMOX FUROX)
Ehrlichiosis: TX
Doxycyline 100 mg PO/IV BID x 7-14 days
