ID PHARM 152 > UTI > Flashcards

UTI Flashcards

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1
Q

Classification of UTIs

A

lower and upper

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2
Q

Define Lower UTI

A

infection of the bladder (cystitis)

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3
Q

Define Upper UTI

A

infection involving the kidneys (pyelonnephritis)

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4
Q

Uncomplicated UTI

A

no structural or functional abnormalities

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5
Q

Complicated UTI

A

Predisposing lesion of the urinary tract- congenital abnormality or distortion of urinary tract, stone, indwelling catheter, prostatic hypertrophy, obstruction or neurological deficit that interferes with normal urinary flow

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6
Q

What types of UTI can males have?

A

males only have complicated

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7
Q

Predisposing Factors

A

Age
Gender
Pregnancy
Use of Spermicides and diaphragms
Instrumentation of urinary system
Urinary tract obstruction- including drugs like anticholinergics
Incomplete bladder emptying
Neurologic dysfunction – stroke, diabetes, spinal cord injury
Vesicoureteral reflux
Renal disease

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8
Q

Which organisms most commonly cause UTI?

A

S. pneumoniae
S. aureus
E. coli
Enterococcus species
Pseudomonas aeruginosa

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9
Q

What is the most common etiology in uncomplicated UTI?

A

E.coli 80%

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10
Q

What are other common etiology in uncomplicated UTI?

A

Staph saprophyticus, K. pneumoniae, Proteus spp., Enterococcus spp.

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11
Q

What are etiology in complicated UTI?

A

E.coli 50%
Staph saprophyticus, K. pneumoniae, Proteus spp., Enterococcus spp.

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12
Q

How to diagnosis UTI?

A

urinalysis - bacteriuria and pyuria
urine culture
you have to have enough in the urine to get the diagnosis

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13
Q

Tests for urine dipsticks

A

for nitrite
- not all bacteria convert nitrates to nitrites
for leukocyte esterase
- esterase activity for WBC

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14
Q

Clinical Presentation lower UTIs

A

dysuria, urgency, frequency, nocturia, suprapublic heaviness/pain, gross hematuria

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15
Q

Clinical Presentation upper UTIs

A

flank pain, fever nausea, vomiting, malaise, costovertebral tenderness

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16
Q

What to consider for treatment for UTIs?

A

Site of infection – cystitis vs pyelonephritis
Renal function
Causative organism
Concurrent disease
Ability to penetrate urine or kidneys
Drug interactions
Adverse effects and allergies
cost

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17
Q

What is the first line for UTI uncomplicated?

A

TMP/SMX
TMP
nitrofurantoin

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18
Q

Which antibiotic is hepatic metabolized?

A

erythromycin

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19
Q

What antibiotics hepatically eliminated?

A

moxifloxacin

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20
Q

How long is nitrofuratoin used for?

A

5 days

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21
Q

what is the dose for TMP/SMX for uncomplicated UTI

A

1 DS bid for 3 days

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22
Q

What is the dose for TMP for uncomplicated UTI?

A

100 mg BID
200 mg daily

for 3 days

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23
Q

What are some alt for first line uncomplicated UTI?

A

cephalexin
fosfomycin

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24
Q

What is the dose for cephalexin for uncomplicated UTI?

A

250 mg QID for 7 days

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25
What is the dose for fosfomycin for uncomplicated UTI?
3 g single dose
26
What is the second line for uncomplicated UTI?
amoxicillin norfloxacin ciprofloxacin
27
What is the dose for amoxicillin for uncomplicated UTI?
500 mg TID for 3-7 days 875 mg BID for 3-7 days
28
What is the dose for norfloxacin for uncomplicated UTI?
400 mg BID for 3 days
29
What is the dose for ciprofloxacin for uncomplicated UTI?
250 mg BID 500 mg ER daily for 3 days
30
What is factors looked at treatment of recurrence?
Culture Re-assess for upper tract infection Re-treat for 7 to 14 days Same antibiotic choices, however tailor based on C&S
31
Define frequent recurrences
short course self treatment at onset of symptoms if less than 3 infections per year
32
Treatment opinions for frequent recurrences
TMP/SMX TMP Macrobid Second line - FQ
33
Dose for frequent recurrent UTI for TMP/SMX
1 tab or 1/2 DS tab qhs 3 times weekly or post-coital if associated with intercourse
34
Dose for frequent recurrent UTI for TMP
100 mg qhs or post coital
35
Dose for frequent recurrent UTI for macrobid
100 mg qhs or post coital
36
Dose for frequent recurrent UTI for FQ
3 times weekly or every other day or post coital
37
List some non-antibiotic therapy
cranberry juice topical (vaginal) estrogen
38
What are factors needed for pharmacist prescribing?
not first episode not pregnant uncomplicated not relapse
39
Which antibiotics have poor renal tissue concentration?
cefotaxime and nitrofurantoin
40
Explain factors for uncomplicated UTI in men
uncommon but an occur urine cultures recommended length is longer 2 wks
41
What are the opinions for non-obstructive mild pyelonephritis?
TMP/SMX (14 d) TMP (14d) norfloxacin ciprofloxacin (7d) levofloxacin (5d) amox/clav (10-14d)
42
What are the opinions for non-obstructive severe pyelonephritis?
Gentamicin + ampicillin ciprofloxacin levofloxacin ceftriaxone + gentamicin
43
Dose for gentamicin for pyelonephritis for gentamicin
4-7 mg/kg q 24 h
44
Dose for gentamicin for pyelonephritis for ampicillin
1-2 g q 4-6 h (IV)
45
Dose for gentamicin for pyelonephritis for ciprofloxacin
400 mg IV q 12 h
46
Dose for gentamicin for pyelonephritis for levofloxacin
250-500 mg q 24h
47
Dose for gentamicin for pyelonephritis for Ceftriaxone
1-2 g IV q24h
48
What is the etiology for bacterial prostatitis?
e.coli 75% other gram negative organisms
49
What is needed for diagnosis for bacterial prostatitis?
urine culture in chronic prostatitis quantitative localization culture
50
List some symptoms of acute bacterial prostatitis
fever, chills, tenderness/pain, malaise, myalgia, frequency, urgency, nocturia and retention
51
List some symptoms of chronic bacterial prostatitis
urinating difficulty, low back pain, perineal and suprapubic pressure
52
Define bacterial prostatitis
Inflammation of the prostate gland and surrounding tissue due to infection Reflux of infected urine into prostate gland
53
Treatment for acute bacterial prostatitis
TMP/SMX, TMP, norfloxacin, levofloxacin , ciprofloxacin
54
Treatment for severe bacterial prostatitis
ampicillin or ceftriaxone IV PLUS gentamicin or tobramycin or amikacin
55
Duration for acute bacterial prostatitis
Total duration minimum 2 weeks; total course should be 4 weeks to prevent chronic infection
56
Treatment for chronic bacterial prostatitis
4 – 12 weeks Fluoroquinolones have better cure rate than TMP/SMX More difficult to get antibiotic penetration into prostate
57
First line for UTI in pregnancy
cephalexin amoxicillin nitrofurantoin
58
Second line for UTI in pregnacy
TMP/SMX TMP avoid in first trimester and in last 6 weeks of pregnacy
59
Dose for UTI for pregnancy for cephalexin
250-500 mg QID 7 days
60
Dose for UTI for pregnancy for amoxicillin
500 mg TID 7 days
61
Dose for UTI for pregnancy for nitrofurantoin
100 mg bid x 5 days
62
When should nitrofurantoin be avoided in pregnancy?
Avoid at term (36-42 weeks gestation and during labor and in neonates)
63
When should TMP/SMX or TMP be avoided in pregnancy?
avoid in first trimester and in last 6 weeks of pregnancy
64
How does Catheterization and UTI relate?
catheterization increase the rate of UTI direct route for bacteria
65
Asymptomatic bacteriuria
Except during pregnancy and/or pre-operative genitourinary procedures, there are no indications for screening or therapy for asymptomatic UTI there is no benefit for elderly may cause harm
66
Nitrofurantoin MOA
damages bacterial DNA/proteins
67
Nitrofurantoin resistance
very slow to develop
68
Nitrofurantoin spectrum
e. coli staphylococci enterococcus faecalis citrobacter klebsiella
69
Nitrofurantoin uses
first line for uncom. cystitis and prophylaxis do not use for pyelonephritis and prostatitis
70
Nitrofurantoin AE
gi upset nausea headache darkens urine
71
Nitrofurantoin rare AE
SJS/TEN
72
Nitrofurantoin AE with long term use
neuropathy pulmonary fibrosis hepatic fibrosis
73
Fosfomycin MOA
inhibits cell wall formation bactericidal
74
Fosfomycin resistance
uncommon unqiue class
75
Fosfomycin spectrum
Enterobacteriaceae including ESBL producers, Enterococcus; does not reliably cover P. aeruginosa
76
Fosfomycin uses
uncomplicated UTI; reserve for allergy or resistance to nitrofurantoin or TMP/SMX; NOT pyelonephritis; considered safe in pregnancy
77
Fosfomycin AE
GI upset, diarrhea, headaches, hypokalemia
78
Fosfomycin dosing
3 gram oral powder x 1 dose; dissolve the powder in ½cup water and drink immediately
79
Nitrofurantoin DI
may increase K combined with spironolactone
ID PHARM 152
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