UTI

Question 1

most common pathogens in acute cystitis

Answer 1

ecoli >80%
staph saprophiticus
klebsiella
proteus mirabillis

Question 2

risk factors for acute cystitis

Answer 2

female 
previous UTI 
sexually active 
pregnancy 
post meno pause 
diabtes 
IC 
obstruction 
urinary reflux
incontinence 
urinary catherter

Question 3

what do you do if men have a UTI

Answer 3

not common have to check for causes such as sti enlaged prostat..

Question 4

signs and symptoms

Answer 4

dysuria - pain when peeing
frequency
urgency
hematuria

Question 5

what are warning signs of something more than a uti

Answer 5

fever
flank pain
vaginal discharge
new sexual partner

Question 6

presentation in the elderly

Answer 6

confusion
GI
loss of appetie

Question 7

when would you do a urine culture/susceptibilty test

Answer 7

recurrent or complicated cases
children
pregnancy women
males

Question 8

some diagnositic tests in urinalysis

Answer 8

microscopic bacterial counts
dipstick for nitrite
leukocyte esterase
microscopic pyuria
hematuria
proteinuria

Question 9

nitrefurantoin dosing

Answer 9

100mg q12h x 5 days

Question 10

when to use nitrofurantoin

Answer 10

mild-mod cystitis
ecoli, klebsiella, saureus, enterococcus
NOT proteus or systemic infection

Question 11

advantages of nitrofurantoin

Answer 11

min resistance low collateral resistance

well tolerated

Question 12

disadvantages of nitrofurantoin

Answer 12

some rare serious advere effects

potential lower bacterial cure rates

Question 13

nitrpfurantoin CI

Answer 13

crcl<30 not recommended
pregnany women term >36 weeks
neonates <1mon
G6PD deficiency - hemplytic anemia

Question 14

adverse effects of nitrofurantoin

Answer 14

hematological, pulmonary and hepatic toxicity

increased risk in elederly renal dysfunction or prolonged use

Question 15

duration of tmpsmx

Answer 15

use the doiuble strength tablet for 3 days

Question 16

who to use tmpsmx in

Answer 16

mild-mod cystitis

ecoli, klebsiella, proteus, saureus particularly if ecoli resistance <20%

Question 17

disadvantages of tmp smx

Answer 17

increasin resistance to ecoli
some concern with collateral resistance
high rate of potentially serious adveres effects - rash, hypersensitivity

Question 18

tmpsmx CI

Answer 18

crcl<10
pregnant
hemolytic anemia

Question 19

alternatives for uti

Answer 19

amoxclav high dose for 7 days

cephalexin high dose for 7 days

Question 20

fosfomycin tromethamine dose

Answer 20

3g x 1 dose

Question 21

use for fosfomycin tromethamine

Answer 21

mid-mod cystitis associated with exoli or efaecalis

Question 22

benefits of fodfomycin tromethamine

Answer 22

rare resistance

Question 23

disadvantages of fosfomycin tromethamin

Answer 23

similar clinical efficacy potentialy lower bacterial efficacy thabut way higher cost

Question 24

which drugs do we try reserve use for uti

Answer 24

fluoroquinolones

Question 25

dosing for fluoroquinolones

Answer 25

use the low dose for 3 days

Question 26

when to use fluoroquinolones

Answer 26

mod-severe complicated including pyelonephritis or suspected resistance

Question 27

advantage of fluoroquinolones

Answer 27

90% bacterial and clinical efficacy well studied cidal work quickly

Question 28

disadvantage of fluorquinolones

Answer 28

collateral resistance | CI in children and pregnany women

Question 29

when cant you use norfloxacin

Answer 29

systemic infections limited to UTI

Question 30

what do you have to do differently in a pregnant woman and children with a uti

Answer 30

get a urine culture confirm treatmetn success with follow up culture children - work up for pyelonephritis, underlying medical condition and anatomical abnormality

Question 31

treatment options for acute cystitis in pregnant women

Answer 31

nitrofurantoin amoxclav cephalexin all for 7 days

Question 32

general treatment for children | *normally will just follow susceptibility results

Answer 32

``` amoxclav cephalexin nitrofurantoin tmpsmx gent + amp/ceftriaxone for pyelonephritis iv ```

Question 33

essential patient counselling for acute uncomplicated cystitis

Answer 33

adherence analgesics fo symptoms follow up if symptoms excedd 2-3 days or relapse

Question 34

mechanism for cranberry juice

Answer 34

active compound inhibit bacterial adherence to uroepithelium lots of variability amoung products not effective for treatment limited data for prevention

Question 35

what is considered a relapse

Answer 35

initial organism within 2 weeks

Question 36

approach to a relapse

Answer 36

urine culture to identify potentially resistant pathogen work up for pyelonephritis retreat as describe for acute cystitis consider 10-14 days

Question 37

what is considered recurrence

Answer 37

2 infections within 6 months or >=3 within 12 months