UTI

Question 1

Name the 4 places in the urinary system where a UTI can occur

Answer 1

Kidneys, ureter(s), bladder or urethra

Question 2

What is the typical bacteria that causes a UTI?

Answer 2

E.Coli

Question 3

Give 3 symptoms of a lower UTI in the bladder

Answer 3

1. Polyuria
2. Dysuria
3. Lower abdominal discomfort

Question 4

What are possible symptoms of a UTI in the urethra?

Answer 4

1. Burning on urination
2. Discharge

Question 5

How can an STI cause a UTI?

Answer 5

Due to the proximity of urethra to vagina

Question 6

Why are UTIs more common in women?

Answer 6

Women have a shorter urethra so easier for bacteria to travel through and there is less distance between the urethra and the anus (compared to men) hence easier for bacteria to get trapped here.

Question 7

Name 3 risk factors of UTIs

Answer 7

1. Sex (woman)
2. Post menopausal women
3. Antibiotic use (disrupts flora)
4. indwelling catheters
5. Sex (urinate after)
6. Pregnancy

Question 8

Who would you refer if you suspected a UTI?

Answer 8

Pregnant woman
Men
Under 16s
Symptoms of pyelonephritis
Signs of sepsis
Non response to antibiotics

Question 9

What is pyelonephritis and what are the symptoms?

Answer 9

Kidney infection
Fever, back pain, flu-like illness, nausea/ vomiting & cold/ shivering

Question 10

What are the signs of sepsis?

Answer 10

Altered mental state, increased HR, low BP, anuria (lack of urine), ashen rash, cyanosis, non-blanching rash

Question 11

Would you perform a urine dipstick test on an over 65? Explain your answer.

Answer 11

No- as asymptomatic bacteria is common and could result in unnecessary antibiotics

Question 12

What would you do to confirm a UTI in an over 65?

Answer 12

Send urine culture- most uncomplicated infections will resolve in that time as you do not get results back straight away

Question 13

What is the exception of prescribing antibiotics for a UTI is there is no symptoms?

Answer 13

If they are pregnant

Question 14

What are the key signs of complex UTI?

Answer 14

Pain on urination
Night time waking to urinate
Cloudy urine

Question 15

What does the urine dipstick test for?

Answer 15

Leukocytes, RBCs and nitrites
(positive= UTI)

Question 16

What would you do if a dipstick result came back positive for leukocytes but negative for nitrites?

Answer 16

Send urine culture as could be UTI

Question 17

What is the drug used for a UTI in pregnant women in the first trimester?

Answer 17

Nitrofurantoin (7 day course)

Question 18

Name 3 increased risk groups of antibiotic resistance

Answer 18

Care home resident
Recurrent UTI
Unresolving symptoms
Hospitalisation >7 days in 6 month
Recent travel with increased resistance
Previous UTI resistance

Question 19

If the patient is at risk of AB resistance what should you do?

Answer 19

Send urine culture

Question 20

How can we help reduce antibiotic resistance?

Answer 20

Use LESS of the 3Cs
ciprofloxacin
cephalosporins
co-amoxiclav

Question 21

Which antibiotic used to treat UTI has a narrow spectrum?

Answer 21

Trimethoprim

Question 22

What is the most common drug for UTI and why?

Answer 22

Nitrofurantoin because although it has a broad spectrum, it is concentrated in the urine and there is a lower risk of resistance compared to trimethoprim

Question 23

What is the dose & duration of nitrofurantoin for UTI?

Answer 23

100mg MR twice a day for 3 days

Question 24

When would trimethoprim be prescribed to treat a UTI and what is the dose and duration?

Answer 24

If there was a low risk of resistance
200mg twice daily for 3 days

Question 25

Why modified release?

Answer 25

Easier regime to follow (taking twice a day is better than taking 4x a day)

Question 26

When can you not prescribe nitrofurantoin?

Answer 26

1. If eGFR is less than 45ml/min - it requires good kidney function to flush it into urinary tract & out (not effective otherwise) 2. G6PD deficiency 3. Acute porphyria 4. Infants under 3 month

Question 27

What can be used as a second line drug for UTI?

Answer 27

Nitrofurantoin if trimethoprim is first choice Pivmecillinam- 400mg initial dose then 200mg 3x a day for 3 days Fosfomycin- 3g single dose sachet

Question 28

What is the MOA of nitrofurantoin?

Answer 28

It is concentrated in the urine and kills bacteria, it is reduced by bacterial flavoproteins to reactive intermediates which inactive/ alter bacterial ribosomal proteins

Question 29

How should you take nitrofurantoin?

Answer 29

With food -to increase bioavailability

Question 30

Name 3 side effects of nitrofurantoin

Answer 30

Nausea/ vomiting Dizzy/ tired Itchy rash Peripheral neuropathy Pulmonary rxns- STOP

Question 31

What would you recommend if a patient was taking nitrofurantoin and presented with an itchy rash/ allergic reaction or swollen salivary glands?

Answer 31

Discontinue! Try a different drug if ongoing issues

Question 32

When should you discontinue nitrofurantoin?

Answer 32

Itchy rash/ allergic rxn/ swollen salivary glands Pulmonary issues Liver issues Blood issues Neurological issues

Question 33

What is the MOA of trimethoprim?

Answer 33

It inhibits DHFR therefore blocks reduction of dihydrofolate to tetrahydrofolate by susceptible organisms

Question 34

What is the active form of folic acid?

Answer 34

Tetrahydrofolate

Question 35

What does trimethoprim interact with and what happens if this interaction was to occur?

Answer 35

Methotrexate- Both antifolates so decreases this which is used to make new DNA Warfarin- causes hyperkalemia which increases risk of HA

Question 36

When should trimethoprim not be prescribed ever?

Answer 36

Blood dyscrasias Pregnancy first trimester (need folate)

Question 37

What are the side effects of trimethoprim?

Answer 37

Mild GI issues nausea/ vomiting Skin rash & pruritis (3-7% patients) Blood disorders (if used long term) *Top 2 reversible when trimethoprim is stopped)

Question 38

What advice would you give to a patient who has a UTI?

Answer 38

Stay compliant with medication Consult GP if and concerns Keep hydrated to flush bacteria out Paracetamol for pain Hygiene (front to back) Empty bladder after sex Birth control