UTI's & Bacterial Prostatitis Flashcards
(19 cards)
Uncomplicated Cystitis
Requires an otherwise healthy, premenopausal female with no structural or functional abnormalities of the urinary tract
Urinary symptoms of a UTI
(not always present)
dysuria and increased frequency
Urinalysis indicative of a UTI
Leukocyte esterase, nitrites, bacteria, WBC’s
Urine Culture indicative of a UTI
Considered significant if > 10^5 with no symptoms
Counts >100CFU/mL & < 100,000 may be considered significant in the presence of urinary symptoms
Systemic signs of infection
- fever
- flank pain
- N/V
- Malaise
Treatment for Asymptomatic Bacteriuria
Screening & tx is indicated ONLY for:
- Pregnant women
- Patients w/ planned urologic procedures w/ anticipated bleeding
Acute Bacterial Prostatitis Management
- Non-severely ill patients can receive oral therapy for 2-4 weeks (Bactrim DS BID < Cipro 500mg BID, Levaquin 500mg QD)
- severely ill patients may require initial IV therapy (IV Cipro > Bactrim; Broad-spectrum PCNs or cephalosporins are appropriate in critical illness)
Chronic Bacterial Prostatitis Management
-4-8 weeks of systemic antibiotics recommended
(FQs > Bactrim)
- May required surgical intervention
Pregnant Women
Bacteriuria has significant consequences (pyelonephritis, prematurity, still birth)
- avoid FQs & doxy, Caution w/ macrobid, and avoid Bactrim after 32 weeks gestation
Patients w/ indwelling catheters
- Remove short-term catheters if possible upon discovery of bacteriuria
- bacteriuria is inevitable w/ long-term catheterization
- initiate antimicrobial therapy if symptoms occur
- prophylactic antibiotics are NOT recommended
Patient’s w/ frequently recurring UTIs (3 or more episodes/yr)
- self- administered short course therapy (initiate w onset of sxs)
- Low dose continuous therapy (avoid if possible due to resistance) –> trimethoprim 100mg QD or Marobid 50-100mg QD
Nitrofurantoin (Macrobid)
- 1st line tx in uncomplicated cystitis (DOC)
- 100mg BID x 5-7 days
- Contraindicatedif CrCl < 60ml/min
- Not effective in pyelonephritis (duh)
- Ensure correct dosage form – Macrodantin = QID; Macrobid = BID
Bactrim DS
- 1st line tx in uncomplicated cystitis
- 800/160mg x 3 days
- assess for hx of sulfa allergies
- Decrease dose to 1/2 if CrCl 15-30ml/min
- Contraindicated if CrCl < 15ml/min
Fosfomycin (Monurol)
- 1st line tx in uncomplicated cystitis
- 3g x 1 dose
- Powder mixed w/ water prior to administration
- no renal or hepatic dose adjustments
- not quite as effective as our other first line options
FQs for treating uncomplicated cystitis
- alternative tx
- Levaquin 250mg QD x 3 days; Cipro 250mg BID x 3 days
- not recommended 1st line due to increasing resistance & ADEs
- reserve for serious or complicated infections (pyelonephritis; prostatitis)
Beta-lactams for treating uncomplicated cystitis
- alternative tx
- courses of 7-10 days w/ close follow-up to ensure clinical improvement
- generally less effective for UTI’s than others
- Only use if 1st line options are not feasible
- Avoid amoxil alone ( use augmentin) –> most E. coli produce beta-lactamases
Initial therapy for Uncomplicated pyelonephritis
- Initial dose of a parenteral antibiotic is recommended
- Ceftriaxone 1g or 5-7mg/kg tobramycin/gentamicin (24 hr dose)
- Max conc. of ceftriaxone for IM use is 350mg/ml ( up to 5mls can be given in 1 site, but multiple sites may decrease discomfort)
Treatment of uncomplicated pyelonephritis in non-hospitalized patients
- Oral FQs x 7 days (Cipro 500mg BID [can substitute IV dose w/ Cipro 400mg IV once]; Levaquin 750mg QD)
- Oral Bactrim DS BID x 14 days
- Oral Beta-lactams are less effective for pyelonephritis (must use a parenteral initial dose & treat for 10-14 days)
Treatment of uncomplicated pyelonephritis in hospitalized patients
- Definitive therapy guided by susceptibility tests
- FQs
- Aminoglycoside +/- ampicillin
- Extended spectrum PCN/Cephalosporin +/- aminoglycosides
- Carbapenems –> reserved strictly for urosepsis
