Urinary Tract Infections Flashcards

Question

empiric therapy for complicated cystitis for women

Answer 1

treat longer: Co-TS for 7 days B lactams for 10-14 days fosfomycin 3g EOD x 3 doses

Answer 2

1. - ciprofloxacin 500mg BD x 7 days - levofloxacin 750mg daily x 5 days 2. Co-TS 800/160mg BD x 14 days 3. B lactams (10-14 days) cephalexin 500mg BD Augmentin 625mg TDS

Answer 3

IV ciprofloxacin 400mg BD or IV cefazolin 1g 8h or IV augmentin 1.2g q8h and/or IV gentamicin 5mg/kg switch to oral when patient can take orally

Answer 4

1. if no indication for prostatitis, and cystitis = regimen same as complicated cystitis in women (longer duration of treatment) 2. if have indication for prostatitis or pyelonephritis: (a) ciprofloxacin 500mg BD (b) Co-TS 800/160mg BD (and treat for 10-14 days, if got prostatitis confirmed, treat for 6 weeks)

Answer 5

Nosocomial: onset of UTI >48hours post admission Healthcare-associated: hospitalisation or underwent invasive urological procedures in last 6 mths

Answer 6

1. IV imipenem 500mg q6h or IV meropenem 1g q8h 2. IV cefepime 2g q 12h +/- IV amikacin 15mg/kg (1 dose) 3. levofloxacin 750mg or ciprofloxacin 500mg BD 4. Co-TS 960mg BD treatment for all is 7-14 days (consider 3 or 4 PO for less sick patients; those that can take orally)

Answer 7

ESBL Ecoli/Kleb/Proteus and P.aeruginosa thus empiric therapy must be broad-spectrum

Answer 8

presence of sx or signs compatible with UTI with no other identified source of infection; have 10^3cfu/ml with >= 1 bacterial species in a catheter urine specimen in patient with: indwelling urethral or suprapubic or intermittent catheter, or mid stream void urine specimen from a patient who had a catheter removed within the previous 48 hours

Answer 9

1. duration of catheterization 2. colonization of drainage bag, catheter and periureteral segment 3. DM 4. female 5. renal function impairment 6. poor quality of catheter care, including insertion

Answer 10

for short term (<7 days): 85% is a single organism long term (>28 days): 95% is polymicrobial (2-3 organisms)

Answer 11

low risk/unlikely <10% are febrile episodes, thus symptomatic infection is uncommon

Answer 12

we can remove the catheter; if a catheter is placed for >2 weeks and its still indicated, catheter has to be replaced to quickly resolve sx and prevent CA-bacteriuria/CA-UTI

Answer 13

1. IV imipenem 500mg q6h or IV meropenem 1g q8h 2. IV cefepime 2g q12h +/- IV amikacin 15mg/kg (1 dose) 3. PO/IV levofloxacin 750mg x 5 days (for mild CA-UTI) 4. Co-TS 960mg BD x 3 days (for women =< 65yo, and no upper urinary tract sx after indwelling catheter has been removed) therapy is for 7 days in those with prompt resolution (deferverse/afebrile) within 72hours and 10-14 days for those with delayed response

Answer 14

1. avoid unnecessary catheter use 2. minimal duration 3. need to change long-term catheter before a blockage happens 4. use a closed system 5. aseptic insertion technique 6. Prophylactic abx not recommended 7. topical antiseptic or abx not recommended 8. chronic suppressive therapy not recommended

Answer 15

1. Avoid: - FQ: anthropathy - Co-TS: first term = defect in neural tubes due to folate antagonism; last term = kernicterus (displace bilirubin into blood); and also G6PD deficiency - Nitrofurantoin: G6PD deficiency - AGs: 8th cranial nerve toxicity (seen in older gen but careful with new gen) Safe in preg: - B lactams (first line treatment) Treatment: 7 days for asymptomatic bacteriuria or cystitis 14 days for pyelonephritis

Answer 16

1. pain and fever: paracetamol or NSAIDS ``` 2. urinary symptoms for dysuria (pain while urination): phenazopyridine (urogesic): use until dysuria stops, topical analgesic effect, cannot use in G6PD deficiency ADR: N/V, orange discoloration of urine and stool ``` or urine alkalization: to relief discomfort in mild uti

Answer 17

. cranberry juice: prevent e coli from adhering to UT epithelial cells . intravaginal estrogen cream: decrease UTI incidence in PMS women; restore normal vaginal flora and protect against e coli colonization . lactobacillus probiotics: intravaginal lactobacillus reduced recurrence of uncomplicated cystitis, restore normal vaginal flora and protect against e coli colonization

Answer 18

1. sx should resolve within 24-72 hours after abx if doesnt resolve with 2-3 days or positive blood/urine culture, need to investigate to exclude resistance, possible obstruction, renal abcess, or other disease 2. reculture has to be taken for preg women after treatment to ensure clearance 3. any ADR, allergies

Urinary Tract Infections Flashcards

(43 cards)