UTIs

Question 1

First line for empiric treatment of uncomplicated cystitis

Answer 1

nitrofurantoin 100mg PO BID x 5 days

SMT 160/80 mg PO BID x 3 days
(if E.coli resist < 20%)

Question 2

Second line for empiric treatment of uncomplicated cystitis

Answer 2

FQs; 250 mg PO x 3 days
cipro BID
levo daily

B-lactams; x 3-7 days
(if penicillin, must have B-lactamase inhibitor)

Question 3

First and second line for empiric treatment of complicated cystitis

Answer 3

Same as uncomplicated, BUT extend duration to x7-10 days depending on symptom resolution

Question 4

First and second line for empiric treatment of catheter-associated UTI

Answer 4

Same as uncomplicated
quick resolution => x7 days
delayed response => x10-14 days

Question 5

First line for empiric treatment of pyelonephritis

Answer 5

ciprofloxacin 500 mg PO BID x 7 days
SMT 160/800 mg PO BID x 14 days
PO B-lactam (first dose IV ceftriaxone)

Question 6

When is is appropriate to treat asymptomatic bacteriuria?

Answer 6

Pregnant women
Upcoming urologic procedure that will dmg mucosa
Kidney transplant within the past month

Question 7

What symptoms differentiate pyelonephritis from cystitis?

Answer 7

Pyelonephritis => more systemic symptoms, flank pain, CVA tenderness

Question 8

What are appropriate indications of fosfomycin to treat UTIs?

Answer 8

for uncomplicated cystitis with ESBL-producing E.coli