UTI

Question 1

When to treat asymptomatic bacteruria

Answer 1

1. Pregnant women (4-7 days)
2. Undergoing endoscopic urologic procedure (1-2 doses)
3. Renal transplant recipients in first 30 days post transplant

Question 2

UA - nitrite positive indicates what bacteria

Answer 2

E. coli
Proteus
Klebsiella

Question 3

UA with casts indicates what

Answer 3

pyelonephritis

Question 4

Uncomplicated cystitis recommended therapy

Answer 4

1. Bactrim DS BI x3 days (avoid if resistance >20% or used for UTI in past 3 months)
2. Nitrobid 100mg BID x5 days (avoid CrCl <30)
3. Fosfomycin 3gm x1

Question 5

Uncomplicated cystitis alternative therapy

Answer 5

1. B-lactams x5-7 days (augmentin, cefdinir, cefaclor, cephalexin, cefpodoxime)
2. FQ (cipro or levo) x3 days

Question 6

Uncomplicated pyelonephritis outpatient therapy

Answer 6

1. Bactrim DS BID x14 days
2. Levaquin 750mg x5 days or cipro 500mg BID x7 days
3. B lactams (augmentin, cefdinir, cefaclor, cephalexin, cefpodoxime) x10-14 days

Question 7

Uncomplicated pyelonephritis outpatient therapy if uropathogen resistance >10%

Answer 7

Initial dose of IV, long-acting B lactam or once-daily aminoglycoside

Question 8

Complicated UTI outpatient therapy

Answer 8

1. Bactrim DS BID x7-14 days
2. Levaquin 750mg daily x5 days or cipro 500mg BID x7 days
3. B lactams x7-14 days (augmentin, cefdinir, cefaclor, cephaexin, cefpodoxime)

Question 9

Complicated UTI Inpatient therapy

Answer 9

Ceftriaxone, FQ, aminoglycoside x5-14 days

Question 10

When anti-pseudomonal B lactam needed for complicated UTI inpatient

Answer 10

Recent hospitalization
Urinary catheter
Living in nursing home

Question 11

Complicated UTI

Answer 11

1. Males
2. Hospital acquired
3. Pregnancy
4. Anatomic abnormality of urinary tract
5. Poorly controlled diabetes
6. Recent antimicrobial use
7. Indwelling catheter
8. Recent urinary tract instrumentation
9. Immunosuppression

Question 12

UTI in pregnancy therapy

Answer 12

1. Augmentin x3-7 days
2. Nitrofurantoin x5-7 days (avoid first trimester)
3. Cephalexin or cefpodoxine x3-7 days
4. Fosfomycin

Question 13

Avoid these ABX for pregnant women

Answer 13

1. FQs
2. Tetracyclines
3. Aminoglycosides
4. Bactrim (especially late 3rd trimester)

Question 14

Treatment duration for UTI relapse

Answer 14

-Infection with same organism within 14 days of discontinuing antibiotics

May need longer (2 week) treatment but assess why the first med failed

Question 15

UTI prophylaxis if 2 or fewer UTIs in 1 year

Answer 15

Patient-initiated therapy (3 day treatments)
Reassess need for ppx every 6-12 months

Question 16

UTI prophylaxis if 3 or more UTIs in 1 year and related to sex

Answer 16

Postintercourse prophylaxis

Bactrim SS
Cephalexin 250mg
Nitrofurantoin 50mg

Question 17

UTI prophylaxis if 3 or more UTIs in 1 year not related to sex

Answer 17

Daily or 3x weekly prophylaxis

Trimethoprim 100mg
Bactrim SS
Cephalexin 250mg
Nitrofurantoin 50mg

Question 18

Treatment if patient with short-term indwelling catheter has asymptomatic bacteriuria

Answer 18

No antibiotics

Question 19

Catheter related UTI, symptomatic therapy, short term indwelling catheter

Answer 19

7 days of ABX
Increase to 10-14 days if delayed response

Levaquin x5 days if not severely ill
3 days if women <65 with catheter removed, no pyelo symptoms

Question 20

Long-term indwelling catheter asymptomatic bacteriuria

Answer 20

No antibiotics
Do not change catheter

Question 21

Long-term indwelling catheter symptomatic bacteriuria

Answer 21

7 days to prevent resistance
Catheter replacement might be indicated

Question 22

Acute bacterial prostatitis

Answer 22

Gram negative organisms

1. Bactrim
2. FQs

2-4 weeks, possible 2 more weeks if remain symptomatic

Question 23

Chronic bacterial prostatitis

Answer 23

1. Bactrim
2. FQs

1-4 months

Question 24

Epididymitis - sexually transmitted

Answer 24

C. trachomatis or N. gonorrheae

Ceftriaxone 500mg (1000mg if >150kg) IM + doxycycline 100mg BID x10 days

Use levofloxacin instead of doxy if anal sex

Question 25

Epididymitis - non sexually transmitted

Answer 25

Enteric gram-negative organisms Common in med with BPH or prostate biopsy, vasectomy, or other urinary tract procedure Levaquin 500mg daily x10 days