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PT2 ID 1-6 > UTI therapeutics > Flashcards

UTI therapeutics Flashcards

(61 cards)

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1
Q

Cystitis

A

-lower UTI (bladder, urethra, urine)

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2
Q

classic triad of symptoms in cystitis

A

dysuria
frequency
urgency

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3
Q

pyelonephritis

A

-upper UTI (kidneys, ureters)

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4
Q

physical symptoms of pyelonephritis

A
  • may included classic triad
  • fever
  • flank pain
  • CVA tenderness
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5
Q

lab indicators of pyelonephritis

A
  • urinalysis showing >10 WBC/hpf
  • urine culture showing >100,000 cfu/mL
  • leukocytosis
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6
Q

uncomplicated urinary infection

A
  • always female
  • no anatomical or neurological impairments
  • treated with oral therapy
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7
Q

complicated urinary infection

A
  • all males, selected females
  • anatomical/neurologic impairments present
  • treat with IV or oral therapy
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8
Q

bacteria that cause uncomplicated UTI

A
  • E.coli 75-95%
  • S.saprophyticus 5-20%
  • other Gm- 5-10%
  • enterococcus 5-10%
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9
Q

bacteria that cause complicated UTI

A
  • <50% E.coli

- >50% other GNB; staph and E.faecalis are common

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10
Q

risk factors for UTI

A
  • female anatomy (short urethra)
  • sexual activity
  • diaphragms and spermicidal agents
  • menopause
  • urinary tract anomolies
  • obstruction of urinary tract
  • suppressed immune system
  • catheter use
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11
Q

most common bacteria in community acquired UTI

A

E.coli
Proteus
Entercoccus

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12
Q

most common bacteria in sexually active female

A
  • staph.saprophyticus
  • E.coli
  • Proteus
  • Enterococcus
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13
Q

most common bacteria in nursing home or hospital acquired UTI

A
  • E.coli
  • Proteus
  • Entercoccus
  • other GNB
  • Staph
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14
Q

elements of urinalysis

A
  • specific gravity
  • protein
  • glucose
  • ketones
  • bilirubin
  • RBC
  • WBC
  • bacteria
  • casts
  • nitrite
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15
Q

why nitrites are looked at in urine

A

bacteria reduce nitrate to nitrite

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16
Q

when to do a urinalysis

A

if they are symptomatic of UTI

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17
Q

When are urine cultures done

A

-usually not after 1st UTI

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18
Q

specific populations that we do urine culture for

A
  • pregnant females
  • elderly patients
  • diabetic pts
  • immunosuppressed pts.
  • males
  • recurrent UTI
  • catheter
  • upper tract infection
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19
Q

when are blood cultures done

A

if the following are present

  • fevers
  • hypotension
  • N/V
  • upper tract infection
  • recurrent urinary infection
  • diabetics
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20
Q

what do we do if patient has positive urinalysis, but asymptomatic

A

do not treat

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21
Q

patients we treat when no symptoms are present but positive urinalysis

A
  • pregnancy
  • children w/ risk factors
  • neutropenic patients
  • post renal transplant patients
  • patients undergoing urologic procedure
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22
Q

3 day therapy for uncomplicated UTI

A
  • usually done
  • TMP/SMZ
  • cephalexin
  • cefuroxime
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23
Q

5 day therapy for uncomplicated UTI

A
  • nitrofurantoin
  • TMP/SMZ
  • various Cephs
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24
Q

standard empiric choice for cystitis

A

TMP/SMZ

unless resistance in area is >20%

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25
back up option for acute uncomplicated UTI
quinolone for 3-5 days after other options are exhausted
26
collateral damage
- killing bacteria that were not involved in the UTI | - leads to resistances of other potentially infectious bacteria
27
collateral damage led to the emergence of what baterial strains
- VRE - KPC pathogens - clostridium defficile - resistant Acinetobacter - SPACE pathogens
28
TMP/SMZ cystitis dosing
1 tab q12h for 3 days
29
cephalexin cystitis dosing
500 mg q6h for 7 days
30
cefdinir cystitis dosing
300 mg q12h for 3-7 days
31
cefpodoxime cystitis dosing
100-200 mg q12h for 3 days
32
amox/clav cystitis dosing
500 mg q8h for 5-7 days
33
fosfomycin cystitis dosing
3 gram for 1 dose
34
nitrofurantoin cystitis dosing
100 mg bid for 5 days
35
nitrofurantoin cystitis contraindication
CrCl under 30 mL/min
36
ciprofloxacin cystitis dosing
250 mg q12h for 3-5 days
37
levofloxacin cystitis dosing
250-500 mg q24h for 3-5 days
38
treatment duration for males
7-10 days
39
treatment duration for males with prostatitis
4 weeks
40
UTI antibiotics with low risk of emergence of resistance and collateral damage
nitrofurantoin | fosfomycin
41
treatment plan for outpatient pyelonephritis
- UA, urine culture - oral therapy if no N/V - tmp/smz - cefuroxime - cefpodoxime - amox/clav
42
TMP/SMZ dosing in outpatient pyelonephritis
1 DS bid for 7-10 days
43
cefuroxime dosing in outpatient pyelonephritis
500 mg q12h
44
cefpodoxime dosing in outpatient pyelonephritis
200-400 mg q12h
45
amox/clav dosing in outpatient pyelonephritis
500 mg q8h OR 875 q12h
46
quinolones to use in outpatient pyelonephritis
ciprofloxacin | levofloxacin
47
usual pathogens in pyelonephritis
``` e.coli enterococcus proteus klebsiella pseudomonas ```
48
drugs for inpatient pyelonephritis
- piperacillin-tazobactam - ceftriaxone - ceftazidime - cefepime - ciprofloxacin - ampicillin/gentamicin - ertapenem
49
generally treatment plan for pyelonephritis in hospital
treat IV until pt is afebrile for 24-48 hours, then complete 7-10 day oral course
50
prostatitis pathogens
- enterobacteriaceae - enterococci - P. aeroginosa
51
prostatitis treatment plan
- for 4 weeks - TMP/SMZ 1 DS bid - cipro 500 mg bid - levo 750 mg qd
52
how long to treat if recurrent prostatitis
at least 6 weeks
53
treatment for nosocomial UTI
- treat for 7-10 days - ampicillin - ceftazidime - cefepime - peperacillin-tazobactam - cipro/levo - ertapenem - vancomycin
54
quinolone that can be used for outpatient pseudomonas
ciprofloxacin
55
treatment for Candiduria
- fluconazole 200 mg po/IV qd for 7-10 | - amphotericin B bladder irrigation
56
candidates for UTI prophylaxis
- uncomplicated urinary tracts - at least 3 UTIs yearly - children with vesicoureteral reflux
57
UTI prophylaxis drugs
- TMP/SMZ 1 half tab qd for 3 weeks - TMP - methenamine - nitrofurantoin - norfloxacin
58
postcoital UTI prophylaxis
same drugs as general UTI prophylaxis drugs but a one time dose
59
UTI suppressive therapy
treat initial UTI but urine will not become sterile due to - urinary stones - urinary structural defects - neurogenic bladder
60
suppressive UTI regimens
- TMP/SMZ - nitrofurantoin - norflaxacin
61
antibiotic counseling points
- complete entire course - drink at least 8 oz water w/antibiotic - ADRs

PT2 ID 1-6 (7 decks)

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