UTI Treatment Flashcards
(28 cards)
What are examples of complicated UTIs?q
All male UTIs
Pregnant females
Immunosuppression
Indwelling catheter
What are predisposing factors for UTIs?
Outlet obstruction (BPH, Strictures)
Female (shorter urethra)
Foley catheter
What are the most common UTI pathogens?
E. Coli
Enterobacteriaceae
-Proteus
-Klebsiella
Staphylococcus saprophyticus
What will be found on urinalysis of UTI?
presence of bacteria
Increase WBC
nitrate positive
What is the most reliable method for diagnosis of UTI?
Urine culture
When should a blood culture be obtained?
Upper UTI
Men >50
Children with any suspicion of invasive involvement
What are the majority of bacterial counts in a urine culture for UTI diagnosis?
> 100,000
But don’t treat just due to bacteriuria alone
When should asymptomatic bacteriuria be treated?
Pregnancy
Undergoing urologic intervention
renal transplant recipients
What all should be considered when treating a UTI?
Achievement of urinary concentrations
-some Abx may not get into bladder
Most likely organisms
Local susceptibility patterns
How should Abx be given for acute uncomplicated bacterial cystitis?
3 days
response should be seen within 48-72 hours
Consider longer treatment if:
-diabetic
-diaphragm use
-patients >65 years old
What are the antibiotic options for uncomplicated cystitis?
Bactrim 160/800 BID x 3 days
Nitrofurantoin 100 BID x 5 days
Fosfomycin 3g x 1
Beta lactams
-amoxicillin/clavulanate
-Cefdinir
When should fluoroquinolones be used to treat uncomplicated cystitis
Only if better options cannot be used
Should be reserved for pyelonephritis or resistant infections if possible
What to note about Bactrim use
Dose reduction if CrCl <30 mL/min
Avoid use if:
-resistant patterns >20%
-Sulfa allergy
-G6PD deficiency
What to note about nitrofurantoin
Macrobid
Food increases absorption
Urine color discoloration
Avoid use:
-early pyelonephritis suspected
-CrCl <60 mL/min
What to note about fosfomycin
Monurol
1 dose
Avoid if pyelonephritis is suspected
What to note about beta-lactams
Duration 3-7 days
Avoid using Amoxicillin or Ampicillin alone
What to note about fluoroquinolone use?
resistance increasing - reserve for complicated if possible
Avoid in age<18
Describe acute uncomplicated pyelonephritis?
sepsis symptoms not present - oral ABx
-infection of pyelocaliceal system
-Symptoms include flank and lower back pain, fever
-Occurrence more common in females and patients >50 years
When does pyelonephritis require hospitalization?
Presence of systemic or more moderate-severe cases
Empiric therapy for 14 days
What are first line for acute uncomplicated pyelonephritis?
FQ of resistance prevalence not > 10%
2nd line for acute uncomplicated pyelonephritis?
Bactrim
Dose reduction with CrCl<30
Avoid with:
-resistance prevalence >20%
-UTI use in past 3 months
- sulfa allergy
Third line for acute pyelonephritis?
Ceftriaxone
What are the IV options if hospitalized with acute pyelonephritis
FQ
Aminoglycoside +/- ampicillin
Carbapenem
How to treat uti in pregnancy
7 days of therapy with amoxicillin, cephalexin, or nitrofirantoin
Avoid:
-tetracyclines
-FQ
-sulfonamides in 3rd trimester
