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Pharmacotherapy > Urinary Tract Infections > Flashcards

Urinary Tract Infections Flashcards

1
Q

Define urinary tract infections (UTI)

A

the presence of microorganisms in the urinary tract, NOT due to contamination

  • broad spectrum of clinical entities
  • self limiting asymptomatic bacteriuria, cystitis, pyelonephritis, UTI with bacteremia, sepsis or death
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2
Q

What is included in upper UTI?

A

Pyelonephritis

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3
Q

What is included in lower UTI?

A

Cystitis
urethritis
prostatitis
epididymitis

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4
Q

For pts of age 0-6months, why are UTI more common in males ?

A

approx 1% prevalence

- higher rate in males due to the higher rate of functional and structural abnormalities in boys

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5
Q

From the age of 65 onwards, what is the prevalence of UTI?

A

Equal
more co-morbidities relating to retention/obstruction of urine (i.e. BPH)
- more urine/bowel incontinence in elderly (may be due to stroke, muscular dysfunction)
- use of urinary catheter more common in elderly regardless of gender

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6
Q

Describe the pathogenesis, risk factors and expected organisms of ascending UTI

A

• Colonic/ fecal flora colonise periurethra area/ urethra
–> ascend to bladder and kidney
• Higher risk in females (shorter urethra), use of spermicides, diaphragms as contraceptives
• Eg of organisms (enterobacteria) – E. coli, Klebsiella, Proteus

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7
Q

Describe the pathogenesis and expected organisms of descending (hematogenous route) UTI

A
  • Organism at distant primary site (eg heart valve, bone) –> bloodstream (bacteremia) –> urinary tract –> UTI
  • Eg of organisms – Staphylococcus aureus, Mycobacterium tuberculosis
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8
Q

When will the hematogenous route be suspected for UTI?

A

Hematogenous route suspected when non-gut bacteria are cultured using urine
- usually will scan the pt for bacteremia and find possible sites of primary infection

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9
Q

Factors determining the development of UTI?

A
  • Competency of the natural host defense mechanisms
  • Size of the inoculums
  • Virulence/pathogenicity of the microorganism
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10
Q

What are some natural host defense mechanisms in UTI?

A
  • Bacteria in bladder stimulates micturition with increased diuresis –> emptying of bladder
  • Antibacterial properties of urine & prostatic secretion
  • Anti-adherence mechanisms of bladder (prevent bacterial attachment to the bladder)
  • Inflammatory response with polymorphonuclear leukocytes (PMNs) –> phagocytosis –> prevent/control spread
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11
Q

What affects the size of inoculum in a pt with UTI?

A

incur with obstruction/ urinary retention

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12
Q

What are examples of virulence/pathogenicity of organisms in UTI?

A

• eg bacteria with pili (eg E. coli) resistant to washout or removal by anti-adherence mechanisms of bladder

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13
Q

What are some risk factors for UTI ?

A
  • Females > males
  • Sexual intercourse
  • Abnormalities of the urinary tract eg prostatic hypertrophy, kidney stones, urethral strictures, vesicoureteral reflux
  • Neurologic dysfunctions eg stroke, diabetes, spinal cord injuries
  • Anti-cholinergic drugs
  • Catheterization and other mechanical instrumentation
  • Diabetes
  • Pregnancy
  • Use of diaphragms & spermicides
  • Genetic association (positive family history)
  • Previous UTI
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14
Q

Why do females have a higher risk of UTI?

A

shorter urethra = easier ascent for bacteria from urethra to bladder

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15
Q

Why is sexual intercourse a risk factor for UTI?

A

increased colonization of bacteria at vaginal area

  • may change vaginal flora
  • can increase ascent of bacteria from urethra to bladder
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16
Q

Why are urinary tract abnormalities a risk factor for UTI?

A

structural abnormalities leading to urinary retention/obstruction

  • strictures –> narrowing of lumen
  • reflux –> backflow due to malfunctions in valves that prevent such backflow –> bacteria can ascend from bladder to kidneys
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17
Q

Why are neurologic dysfunctions a risk factor for UTI?

A

pts are more likely to have urinary retention

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18
Q

Why are anti-cholinergic drugs a risk factor for UTI?

A

key side effect is urinary retention (1st gen anti-hist, atropine) –> cannot remove bacteria in urine

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19
Q

Why is catherization and other mechanical instrument a risk factor for UTI?

A

includes laproscopy tube
- tubes can habour growth of bacteria (formation of biofilm possible) –> increase in inoculum and access to urinary tract

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20
Q

Why is diabetes a risk factor for UTI?

A

can have some neuropathy + high urine sugar content promote bacteria growth

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21
Q

Why is the use of diaphragms and spermicides a risk factor for UTI?

A

exact reason not known, perhaps due to alteration in flora in peri-urethral/vaginal area –> more colonization and increase in size of inoculum

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22
Q

What do we refer to when we say genetic association is a risk factor for UTI?

A

specifically 1st degree female relatives

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23
Q

What are some non-pharms to prevent UTIs?

A
  • Drink lots of fluid to flush the bacteria. Go for 6-8 glasses a day. (if feasible)
  • Urinate frequently and go when you first feel the urge.
  • Urinate shortly after sex. This can flush away bacteria that might have entered your urethra during sex.
  • After using the toilet, always wipe from front to back, especially after a bowel movement.
  • Wear cotton underwear and loose-fitting clothes so that air can keep the area dry.
  • For women, using a diaphragm or spermicide for birth control can lead to UTIs. Unlubricated condoms or spermicidal condoms increase irritation, which may help bacteria grow.
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24
Q

Define complicated UTI

A
  • Complicated: UTI associated with conditions that increase the potential for serious outcomes, risk for therapy failure
  • Eg UTIs in men, children and pregnant women
  • Presence of complicating factors
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25
Q

What are some complicating factors for UTI?

A

functional and structural abnormalities of urinary tract, genitourinary instrumentation, diabetes mellitus, immunocompromised host

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26
Q

How can we classify an uncomplicated UTI?

A

No complicating factors

• Usually in healthy premenopausal, non-pregnant women with no history suggestive of an abnormal urinary tract

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27
Q

How do we diagnose uncomplicated UTI?

A

Infection usually suspected based on typical symptoms

- Urinalysis and culture not routinely needed for cystitis but recommended for pyelonephritis

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28
Q

How do we diagnose Complicated UTI?

A

Typical symptoms or atypical symptoms (catherization, altered mental status, impaired sensation)
- Urinalysis and culture indicated

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29
Q

What can we expect with regards to antimicrobial resistance in uncomplicated UTI?

A

Common but generally predictable

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30
Q

Does Antimicrobial resistance alone warrant the designation complicated UTI?

A

No

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31
Q

What can we expect with regards to antimicrobial resistance in complicated UTI?

A

Multidrug resistance common and less predictable

- FQ resistance common

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32
Q

Recall the 4 steps of systematic approach to antimicrobial therapy

A
  1. Confirm presence of infection (indication for antibiotics)
    • Risk factors for infections
    • Subjective evidence
    • Objective evidence
    • What is the (possible) site of infection
  2. Identification of pathogens
    • What is the (likely) pathogen
    • Any microbiological test sent or results available
  3. Selection of antimicrobial and regimen
    • Empiric, definitive or prophylaxis
    • Consider organism, host and drug factors
    • Decide on choice of agent, route, dosing and duration of treatment
  4. Monitor response
    • Therapeutic response
    • Adverse drug reactions
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33
Q

What are some Subjectives for UTI (cystitis)?

A

• lower urinary tract infections (cystitis)

- dysuria, urgency, frequency, nocturia, suprapubic heaviness or pain; gross hematuria

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34
Q

What are some Subjectives for UTI (pyelonephritis)?

A

• upper urinary tract infections (pyelonephritis)
- fever, rigors, headache, nausea, vomiting and malaise, flank pain, costovertebral tenderness (renal punch), or abdominal pain

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35
Q

What are some things to note when evaluating Subjective evidence for UTI?

A
  • Sx may not clearly point towards pyelonephritis/cystitis and there can be other reasons for these sx presentations as well
  • Esp When UTI occurs frequently for elderly, they frequently do not experience urinary sx but can present w altered mental status, i.e. being more drowsy, less alert, change in eating habits and general GIT sx
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36
Q

What are some Objectives for UTI?

A

Urine sent for urinalysis (i.e. UFEME, chemical analysis) and culture

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37
Q

What are the 3 methods of urine collection for UTI?

A

1) Midstream clean-catch
2) Catheterization
3) Suprapubic bladder aspiration

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38
Q

How can we perform Midstream Clean-catch properly?

A

discard the 1st 20-30mL, collects the next 20-30mL)

- 1st 20-30mL urine possibly contaminated w urethral colonizers –> discard

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39
Q

What is a key difference between pyelonephritis and cystitis with regards to objective evidence?

A

Pyelonephritis usually has more objective evidence of systemic infections i.e. higher temp, increased total WBCs, neutrophils, increased CRP, procalcitonin

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40
Q

What are the parameters covered in UFEME (Urine Formed Elements and Microscopic Examination)

A

WBCs
RBCs
Microbes
WBC casts

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41
Q

How can we rationalize WBCs in UFEME?

A
  • > 10 WBCs/mm3 = pyuria
  • Signifies presence of inflammation, may or may not be due to infection.
  • In a symptomatic patient, pyuria correlates with significant bacteriuria
  • Absence of pyuria = unlikely UTI
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42
Q

How can we rationalize RBCs in UFEME?

A

• Presence (microscopic >5/ HPF or gross) = hematuria
• Frequently occurs in UTI but non-specific i.e. if menses or other reasons leading to hemorrhage of urine tract
- hematuria can be due to trauma (i.e. when there is catheterization, stones, malignancy)

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43
Q

How can we rationalize WBC casts in UFEME?

A
  • masses of cells and proteins that form in renal tubules (in kidneys)
  • indicate upper tract infection / disease
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44
Q

What are the Microbial test(s) done in UFEME?

A

• Identify bacteria or yeast using Gram-stain

45
Q

What are the chemical analysis tests for UTI?

A

Dipsticks

  • Nitrite
  • Leukocyte esterase
46
Q

How can we rationalize the nitrite dipstick test in chemical analysis?

A
  • Positive test detects presence of Gram-negative bacteria
  • Requires at least 10^5 bacteria/ml
  • Only Gram-negative organisms reduces nitrate to nitrite
  • False-negative results due to presence of Gram-positive organisims and P. aeruginosa, low urinary pH, frequent voiding and dilute urine.
47
Q

How can we rationalize the leukocyte esterase dipstick test in chemical analysis?

A
  • Positive test detects esterase activity of leukocytes in urine
  • Correlates with significant pyuria (>10 WBCs/mm3)
48
Q

When should we NOT obtain urine cultures?

A

NOT necessary in uncomplicated cystitis

  • as it has been found that positive urinary dipsticks are very predictive of uncomplicated UTI –> easily treated –> no need to know identity of bacteria
  • can just give general empirical abx and pt will respond
49
Q

When are pre-treatment cultures necessary?

A
  • Pregnant women
  • Recurrent UTI (relapse within 2 weeks or frequent)
  • Pyelonephritis
  • Catheter-associated UTI
  • All men with UTI
50
Q

What is the likely pathogen for uncomplicated or community acquired UTIs?

A
  • Escherichia coli (>85%)
  • Staphylococcus saprophyticus (5-15%) –> common urinary tract colonizer
  • Others: Enterococcus faecalis, Klebsiella pneumoniae, Proteus spp

*gut enterobacteriacae (commonly causing UTI via ascending route) with E coli being the most common

51
Q

What is the likely pathogen for complicated or healthcare associated UTIs?

A
  • E. coli (around 50%)
  • Enterococci
  • Proteus spp, Klebsiella spp, Enterobacter spp, P. aeruginosa
  • additionally, ESBL/MDR strains of bacteria may be present, i.e. ESBL E Coli, proteus, klebsiella etc…
52
Q

What are the healthcare associated factors?

A 
Hospitalization in the last 90 days
Current hospitalization ≥ 2 days
Residence in nursing home
Antimicrobial use in the last 90 days
Home infusion therapy
Chronic dialysis
53
Q

What are some other pathogens that can cause UTI?

A
  • S. aureus – commonly due to bacteremia; consider other primary site of infections
  • Yeast or Candida – possible contaminant; consider other sites of infection
54
Q

When there is a positive urine culture. is there a need to treat UTI?

A

Yes if the pt is symptomatic
No if asymptomatic (except for 1. pregnant women 2. pts undergoing invasive urologic procedures with mucosal trauma e.g. TURP, cystoscopy with biopsy)

55
Q

How are prophylactic abx given for surgery in the context of UTI?

A

Obtain culture then start antibiotics based on culture & sensitivity 12-24 hrs before procedure

56
Q

What are the 1st line treatment options for EMPIRIC therapy for uncomplicated Cystitis in women (community acquired)?

A
  • PO co-trimoxazole 800/160 mg bid x 3d or
  • PO nitrofurantoin 50 mg qid x 5d
  • PO fosfomycin 3 g single dose
57
Q

What are the alternative treatment options for EMPIRIC therapy for uncomplicated Cystitis in women (community acquired)?

A

PO beta-lactams x 5-7 days:
• PO cefuroxime 250 mg bid
• PO cephalexin 500 mg bid
• PO amoxicillin-clavulanate 625 mg bid

PO fluoroquinolones x 3 days:
• PO ciprofloxacin 250 mg bid
• PO levofloxacin 250 mg daily

58
Q

What are the changes in treatment options for EMPIRIC therapy for COMplicated Cystitis in women (community acquired)?

A

Treat for longer duration eg 7 to 14 days
7 - 14 days for co-trimoxazole
10 - 14 days for beta lactams
- Fosfomycin dose for complicated cystitis: PO 3 g EOD x 3 doses

*EOD - every other day

59
Q

What are the Empiric Antibiotics for Community-acquired Pyelonephritis in women

A

PO fluoroquinolones
• PO ciprofloxacin 500 mg twice daily x 7 days or
• PO levofloxacin 750 mg daily x 5 days or
PO co-trimoxazole 160/800 mg twice daily x 14 days or
PO Beta-lactam x 10-14 days
• PO cephalexin 500 mg bid
• PO amoxicillin-clavulanate 625 mg tds

60
Q

What are the Empiric Antibiotics for Community-acquired Pyelonephritis in women who are severely ill who require hospitalization/unable to take oral drugs?
- i.e. N/V

A
  • [IV ciprofloxacin 400mg bid or IV cefazolin 1g q8h or IV amoxi-clav 1.2g q8h] and/or [IV/IM gentamicin 5mg/kg]
61
Q

What is something to note when deciding on duration of abx after culture results return?

A

We count only the duration of active abx –> esp when urine culture results come back and we need to switch to new abx i.e. abx change to cipro despite pt being on co-trimox for 6days –> pt must finish 7 days of cipro now

62
Q

Empiric Antibiotics for community-acquired UTI in Men (Cystitis without concern for prostatitis)

A

Use regimen as per complicated cystitis in women (treat for longer duration)

63
Q

Empiric Antibiotics for community-acquired UTI in Men (Cystitis with concern for prostatitis or Pyelonephritis)

A
  • PO ciprofloxacin 500mg twice daily or
  • PO co-trimoxazole 800/160 mg twice-daily
  • Treat for 10-14 days, will need longer duration if prostatitis is confirmed (6 weeks)
64
Q

What are the s/sx of prostatitis?

A
  • localized pain
  • scrotal pain
  • pain on ejaculation
  • voiding difficulties
  • such pts usually sent to urologists for more detailed checks
65
Q

How can we detect nosocomial/healthcare associated pyelonephritis?

A
  • Nosocomial – onset of UTI >48h post admission
  • Healthcare associated - patients who have been hospitalized or underwent invasive urological procedures in the last 6 months, has an indwelling urine catheter, etc

*catheters are the most common cause of nosocomial UTI

66
Q

What are the additional organisms that we have to cover in empiric therapy for nosocomial/healthcare associated pyelonephritis?

A

The possibility of Pseudomonas aeruginosa and other resistant bacteria (eg ESBL producing E coli and
Klebsiella) should be considered and broad-spectrum B-lactam may be used for empiric therapy.

67
Q

Empiric Antibiotics for Nosocomial/ Healthcare associated Pyelonephritis

A
  • IV cefepime 2g q12h +/- IV amikacin 15mg/kg/d or
  • IV imipenem 500mg q6h or IV meropenem 1g q8h
  • PO levofloxacin 750mg (for less sick patients)
  • PO ciprofloxacin 500mg bid (for less sick patients)
  • Duration of treatment is 7-14 days (7 if pt responds well)
68
Q

How can we define catheter associated UTI (CA-UTI)?

A

• Presence of symptoms or signs compatible with UTI with no other identified source

  • 10^3 cfu/mL of ≥1 bacterial species in a single catheter urine specimen
  • catheterization
  • midstream catch from a patient whose catheter has been removed within the previous 48 h
69
Q

What are the risk factors for CA-UTI?

A
  • Duration of catheterisation (KEY)
  • Colonisation of drainage bag, catheter and periurethral segment
  • DM
  • Female
  • Renal function impairment
  • Poor quality of catheter care, including insertion
70
Q

What are the causative organisms of CA-UTI?

A
  • Short-term catheterisation (<7 days) – 85% single organisms – E coli, klebsiella
  • Long-term (>28 days) – 95% polymicrobial (2-3 organisms) - E coli, klebsiella, pseudomonas
71
Q

What are the morbidity and mortality characteristics relating to CA-UTI?

A
  • Symptomatic manifestation uncommon
  • Studies in long-term care facilities showed <10% febrile episodes due to UTI
  • Usually low-risk or not associated with excess mortality
72
Q

Is treatment of asymptomatic CA-UTI recommended?

A

• Treatment of asymptomatic bacteriuria not recommended except prior to traumatic urological procedures

73
Q

How can we treat CA-UTI (non-pharms)?

A
  • Removal of catheter should always be considered
  • If an indwelling catheter has been in place for >2 weeks at the onset of CA-UTI and is still indicated, the catheter should be replaced
74
Q

What are some symptoms of CA-UTI?

A 
New onset or worsening of fever
rigors
altered mental status
malaise, or lethargy with no other identified cause
flank pain
costovertebral angle tenderness
acute hematuria
pelvic discomfort.
75
Q

How should we treat a patient with CA-UTI that is stable with a low grade fever?

A

Consider observation rather than immediate antibiotics therapy

76
Q

What do we have to do before administering abx for a pt with CA-UTI?

A

Urine (+/- blood) culture must be taken before antibiotics is given
*Since CA-UTI likely to have resistant organisms

77
Q

Empiric abx options for CA-UTI?

A
  • IV imipenem 500mg q6H or IV meropenem 1g q8h
  • IV cefepime 2g q12H +/- IV amikacin 15mg/kg (1 dose)
  • PO/ IV levofloxacin 750mg x 5d (for mild CA-UTI)
  • PO Co-trimoxazole 960mg bid x 3d (for women ≤65 years with CA-UTI without upper urinary tract symptoms after an indwelling catheter has been removed)
78
Q

What is the usual duration of tx for CA-UTI?

A

• Duration of treatment: usually 7 days in those with prompt resolution of symptoms (i.e. deferverse in 72 hrs)
- 10–14 days of treatment for those with a delayed response

79
Q

How can we prevent CA-UTI?

A
  • Avoid unnecessary catheter use (i.e. do trial of catheter for pts)
  • Use for minimal duration
  • Long-term indwelling catheters changed before blockage is likely to occur
  • Use of closed system
  • Ensure aseptic insertion technique
80
Q

What are 3 kinds of abx usage not recommended for CA-UTI?

A
  • Topical antiseptic or antibiotics
  • Prophylactic antibiotics and antiseptic
  • Chronic suppressive antibiotics
81
Q

What are some abx to avoid in pregnancy?

A

FQs
Co-trimoxazole (1st and 3rd trimester)
Nitrofurantoin (3rd trimester)
AGs (caution)

82
Q

What is the usual treatment for pregnant pts with UTI?

A

Beta lactams (1st line)
• Choice of antibiotics based on cultures
• Treat for 7 days for asypmtomatic bacteriuria or cystitis
• Treat for 14 days for pyelonephritis

83
Q

Cephalexin
• Normal dose, frequency and duration for different
classification of UTIs
• Patient counseling points
• Monitoring parameters (for common side effects)

A
  • Cystitis: PO 500mg bd x 3-7d

- Pyelonephritis: PO 500mg-1g bd x 14d

84
Q

Cephalexin

• Normal dose, frequency and duration for different classification of UTIs

A
  • Cystitis: PO 500mg bd x 3-7d
  • Pyelonephritis: PO 500mg-1g bd x 14d
  • Some refs quote BD dosing. but in practice, it is given QDS –> 250-500mg q6h
  • BD dosing ok for uncomplicated cystitis (easy to tx infection)
85
Q

Cephalexin

• Patient counseling points

A

Take without regards to food, if GI discomfort, take with food.

86
Q

Cephalexin

• Contraindication/Precaution/pregnancy/ADR

A

<10% cross-sensitivity for penicillin allergy (avoid if anaphylaxis).
Generally safe in pregnancy

ADR: GI

87
Q

Co-trimoxazole

• Normal dose, frequency and duration for different classification of UTIs

A
  • Cystitis, women: PO 960mg bd x 3d
  • Cystitis, men: PO 960mg bd x 7-14d
  • Pyelonephritis: PO 960mg bd x14d

*SMZ 800mg/ TMP 160mg

88
Q

Co-trimoxazole

• Patient counseling points

A

N/V (take after food), photosensitivity, adequate hydration to prevent crystalluria,

Discontinue at first sign of rash.

89
Q

Co-trimoxazole

• Contraindication/Precaution/pregnancy/ADR

A

ADR: nausea, vomiting, myelosuppression, SJS, hyperkalemia, hepatotoxicity, photosensitivity

Avoid in sulpha allergy, G6PD def, 1st & 3rd trimester pregnancy, CrCl < 15ml/min, folate deficiency.

90
Q

Ciprofloxacin

• Normal dose, frequency and duration for different classification of UTIs

A
  • Cystitis, women: PO 250mg bd x 3d
  • Cystitis, men: PO 500mg bd x 7-14d
  • Pyelonephritis: PO 500mg bd x 7-14d (7d in women)
91
Q

Ciprofloxacin

• Patient counseling points

A

GI upset (take w food). Administration apart from Ca, Fe.

CNS (headache, dizziness), photosensitivity. Tendon inflammation (discontinue at first sign of pain, esp in elderly).

92
Q

Ciprofloxacin

• Contraindication/Precaution/pregnancy/ADR

A

Avoid in pregnancy, children, patient with altered cardiac conduction

Caution in pt at risk of seizures.

ADR: tendon inflammation, hypo/hyperglycemia, photosensitivity, QTc prolongation

93
Q

Nitrofurantoin

• Normal dose, frequency and duration for different classification of UTIs

A
  • Cystitis: PO 50-100mg qds x 5d
94
Q

Nitrofurantoin

• Patient counseling points

A

Take with food (incr absorption, reduce GI upset). Nausea, headache, dark coloured urine.

95
Q

Nitrofurantoin

• Contraindication/Precaution/pregnancy/ADR

A

Not for pyelonephritis

Avoid in renal impaired Crcl < 30ml/min, pregnancy at term (38-42 weeks), G6PD def

ADR: GI, Pulmonary fibrosis (unexplained malaise, cough, SOB). Tingling extremities (neuropathy) with dose-accumulation

96
Q

Augmentin

• Normal dose, frequency and duration for different classification of UTIs

A

Cystitis: PO 625mg bd x 3-7d
Pyelonephritis: PO 625mg bd/tds x 10-14d

97
Q

Augmentin

• Patient counseling points

A

Take with/ without food.

Nausea, vomiting, diarrhoea

98
Q

Augmentin

• Contraindication/Precaution/pregnancy/ADR

A

Avoid in penicillin allergy, history of hepatic impairment with Augmentin/penicillin. Generally safe in pregnancy

ADR: cholestatic jaundice, GI esp diarrhea, vaginal mycosis

99
Q

Fosfomycin

• Normal dose, frequency and duration for different classification of UTIs

A

Cystitis: PO 3g single dose

Complicated cystitis, CA-UTI: PO 3g EOD x 3 doses

100
Q

Fosfomycin

• Patient counseling points

A

Take with/ without food.

Headache, diarrhoea

101
Q

Fosfomycin

• Contraindication/Precaution/pregnancy/ADR

A

Not for pyelonephritis, not for CrCl<30ml/min

ADR: headache, diarrhoea, vaginitis

102
Q

What are the adjunctive therapy available for UTI?

A
  • Pain and fever – paracetamol or NSAIDs
  • Vomiting – rehydration

Urinary symptoms
- Phenazopyridine (Urogesic®) or Urine alkalization (relief in mild UTI, unproven benefit)

103
Q

Phenazopyridine (Urogesic®) Dose and duration?

A

• Dose: 100-200mg tds

treatment should be limited for the duration of symptoms

104
Q

Phenazopyridine (Urogesic®) Precautions/ADR?

A
  • Do not use in G6PD deficiency

* ADR: nausea, vomiting, orange-red discolouration of urine and stool

105
Q

Non-antimicrobial options for UTI prevention?

A

Cranberry juice
Intravaginal estrogen cream
Lactobacillus Probiotics

*May require more evidence but no harm trying

106
Q

What is the goal of UTI tx?

A

1) Resolution of signs & symptoms
2) Bacteriological clearance
3) Absence of adverse drug reactions and allergies

107
Q

By when can we expect Resolution of signs and symptoms in UTI if effective abx was given?

A
  • Improvement or resolution by 24 to 72 hrs after initiation of effective antibiotics
108
Q

What should be done if patient does not respond clinically within 2-3 days or has persistent positive urine/blood cultures?

A

Further investigation is needed to exclude bacterial resistance, possible obstruction, renal abscess, or some other disease process

109
Q

What should we note for Bacteriological clearance in UTI?

A
  • Repeat culture is not required for patients who responded

- Culture to document clearance of infection for Pregnant women

Pharmacotherapy (10 decks)

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