UTI

Question 1

What are the medications used for UTI

Answer 1

Phenazopyridine (pain analgesic)
Beta-lactam + oxapenem/aminopenicillins (Amoxicillin-Clavulanate)
2nd gen fluoroquinolones (Ciprofloxaxin)
Sulfonamides (Trimethoprim-sulfamethoxazole/TMP-SMZ/Bactrim)
Novel class (Fostomycin)
DNA synthesis inhibitors (Nitrofuratoin)

Question 2

Names of Beta-lactam abx + oxapenem/aminopenicillin

Answer 2

Amoxicillin/Clavulanate

Question 3

Name of 2nd gen fluoroquinolone

Answer 3

Ciprofloxacin

Question 4

Name of sulfonamides

Answer 4

Trimethoprim-Sulfamethoxazole (TMP-SMZ/Bactrim)

Question 5

Name of novel class

Answer 5

Fosfomycin

Question 6

Name of DNA synthesis inhibitors

Answer 6

Nitrofurantoin

Question 7

MOA of beta-lactam abx + oxapenem/amoxicillin+clavulanate

Answer 7

Inhibit bacterial cell wall synthesis (inhibit transpeptidation)

Question 8

Why is amoxicillin/clavulanate used

Answer 8

For its extended spectrum action

Question 9

AE of amoxicillin/clavulanate

Answer 9

Generally well tolerated
Rash & diarrhoea are most common AE
1-4% get allergic reaction - severe hypersensitivity that are potentially fatal (SJS)
Thrombophlebitis (inflammation @ injection site)

Question 10

MOA of ciprofloxacin/2nd gen fluoroquinolones

Answer 10

DNA synthesis inhibitor

Question 11

Why is ciprofloxacin used for

Answer 11

Broad spectrum action - concentration-dependent killing

Question 12

Why is ciprofloxacin not used anymore as a first choice drug

Answer 12

Increasing resistance

Question 13

AE of ciprofloxacin

Answer 13

Nausea, diarrhoea, vomiting, headache, restless, pain & inflammation @ injection site, anaphylaxis, tendon rupture, superinfection, photosensitivity, pseudomembrane colitis, seizure, peripheral neuropathy & hepatotoxicity

Question 14

Who should not use ciprofloxacin

Answer 14

Elderly with tendonitis & athletes with tendon rupture

Question 15

MOA of trimethoprim-sulfamethoxazole (TMP-SMZ/Bactrim)

Answer 15

Inhibit folate synthesis - synergistically inhibit folate synthesis (2 step process: sulfamethoxazole inhibit dihydropteroate synthase [1st step to making nucleic acid] trimethorpim inhibit dihydrofolate reductase [2nd step to making nucleic acid]) & kill bacteria effectively

Question 16

Why is trimethoprim-sulfamethoxazole not used as a first choice urinary septic drug

Answer 16

Due to increasing resistance of drug

Question 17

AE of trimethoprim-sulfamethoxazole

Answer 17

Nausea, vomiting, anorexia, rash, photosensitivity, crystalluria, anaphylaxis, blood dyscrasia, fulminant hepatic necrosis, hyperk, SJS

Question 18

MOA of fosfomycin

Answer 18

Inhibit bacteria cell wall synthesis - inhibit transglycosylation

Question 19

Why is fosfomycin used

Answer 19

Specific for urinary system
Safe for pregnant women
Can be used if pt is resistant to ciprofloxacin (fluoroquinolones)/trimethoprim-sulfamethoxazole
Can also be used in place of amoxicillin-clavulanate

Question 20

AE of fosfomycin

Answer 20

Nausea, diarrhoea, headache, back pain, anaphylaxis, superinfection

Question 21

MOA of nitrofurantoin

Answer 21

DNA synthesis inhibitor which disrupt nucleic acid synthesis via oxidative stress (work like metrodinazole)

Question 22

Why is nitrofurantoin used

Answer 22

Specific coverage for UTI infections

Question 23

AE of nitrofurantoin

Answer 23

Nausea, vomiting, anorexia, dark brown urine, anaphylaxis, superinfections, hepatic necrosis, interstitial pneumonitis, SJS

Question 24

Which classes are susceptible to SJS

Answer 24

Nitro & sulfa groups (nitrofurantoin & trimethoprim-sulfamethoxazole)

Question 25

Why are oxapenems used with beta lactam abx

Answer 25

To prevent beta lactam abx from being destroyed by beta-lactamase produced by bacteria (combat resistance)

Question 26

Popular combinations of beta-lactam + oxapenem

Answer 26

Amoxicillin/Clavulanic acid or Clavulanate Ticarcillin/Clavulanate Pipericillin/Tazobactam Ampicillin/Sulbactam

Question 27

Which medications can be used for pregnant women

Answer 27

Amoxicillin & fosfomycin

Question 28

What can be used to treat MRSA

Answer 28

Vancomycin & sulphonamides

Question 29

What is the empirical treatment of pyelonephritis

Answer 29

IV Ceftriaxone

Question 30

What is the alternative treatment for pyelonephritis

Answer 30

Pipericillin/tazobactam

Question 31

What is the ideal pH for urinary system when taking nitrofurantoin to exert its greatest effect

Answer 31

5.5

Question 32

What is a single dose (100mg) of nitrofurantoin good for

Answer 32

Prevent recurrent uncomplicated UTI in some women

Question 33

What is the empirical treatment for cystitis

Answer 33

Nitrofurantoin

Question 34

What are the alternative treatment for cystitis

Answer 34

Trimethoprim-sulfamethoxazole (TMP-SMZ/Bactrim) Fosfomycin

Question 35

Why is fosfomycin a less efficacious drug

Answer 35

Pseudomonas & Acinebacter may be resistant to it

Question 36

What medication should be given to a female who got UTI for the first time without any hx of use of common abx

Answer 36

Amoxicillin-Clavulanate & Cotrimoxazole (trimethoprim-sulfamthoxazole)

Question 37

What medication should be given to a female who has gotten recurrent UTI and has been prescribed abx before

Answer 37

Nitrofurantoin

Question 38

What medication should be given to a pregnant lady with UTI

Answer 38

Fosfomycin

Question 39

What mediation should not be given to a UTI patient with allergy to penicillin

Answer 39

Beta lactam abx

Question 40

What medication should not be given to a UTI patient with allergy to sulfa

Answer 40

Cotrimoxazole (Trimethoprim-Sulfamethoxazole)

Question 41

What medication should not be given to a UTI patient with G6PD

Answer 41

Cotrimoxazole (Trimethoprim-Sulfamethoxazole) & Nitrofurantoin

Question 42

What medication should not be given to an elderly patient with UTI and cardiac dysrhythmia

Answer 42

Fluoroquinolone (Ciprofloxacin)

Question 43

What to do when all treatment has failed and there is bacterial resistance

Answer 43

Refer to hosp guidelines & check resistance patterns