Last Lap Preparation > UTI > Flashcards

UTI Flashcards

(51 cards)

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1
Q

What are the goals of therapy for urinary tract infections (UTIs)?

A
  • Relieve symptoms in acute infection
  • Prevent complications of untreated acute infection
  • Prevent recurrent infection
  • Prevent pyelonephritis in pregnancy

These goals guide the management and treatment of UTIs.

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2
Q

What is the difference between relapse and reinfection in urinary tract infections?

A
  • Relapse: recurrence with the same organism within 4 weeks after treatment
  • Reinfection: recurrence with a new species or strain >2 weeks after treatment

Relapse is due to persistence of the organism, while reinfection follows ascension from the periurethral area.

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3
Q

What are the common infecting organisms in acute uncomplicated UTI (cystitis)?

A
  • Escherichia coli (80–90%)
  • Staphylococcus saprophyticus (5–10%)
  • Klebsiella pneumoniae
  • Proteus mirabilis

Escherichia coli is the most frequent organism causing UTI.

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4
Q

True or false: Urine culture is generally recommended for acute uncomplicated UTI (cystitis).

A

FALSE

Clinical diagnosis is reliable for most episodes; culture is only indicated in specific circumstances.

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5
Q

What are the indications for urine culture in acute nonobstructive pyelonephritis?

A
  • Always indicated
  • Obtain urine specimen before initiating antimicrobial therapy
  • Consider blood cultures

A urine specimen should be obtained to confirm the diagnosis before starting treatment.

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6
Q

What are the first-line therapies for acute uncomplicated UTI (cystitis)?

A
  • Nitrofurantoin PO × 5 days
  • SMX/TMP PO × 3 days
  • Trimethoprim PO × 3 days
  • Fosfomycin tromethamine PO × 1 dose

These options are effective for treating acute uncomplicated UTI.

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7
Q

What is the recommended treatment duration for mild to moderate pyelonephritis?

A
  • Ciprofloxacin or levofloxacin PO × 7–14 days
  • SMX/TMP PO × 10–14 days
  • Trimethoprim PO × 10–14 days
  • Amoxicillin/clavulanate PO × 10–14 days

Treatment duration varies based on the severity of the infection.

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8
Q

What are the common symptoms of acute bacterial prostatitis?

A
  • Acute onset chills
  • Fever
  • Perineal and low back pain
  • Irritative and obstructive voiding

The prostate is typically tender, swollen, and warm during examination.

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9
Q

What is the treatment for chronic bacterial prostatitis?

A
  • Ciprofloxacin or levofloxacin PO × 4–6 weeks
  • SMX/TMP PO × 4–6 weeks

Chronic prostatitis often causes recurrent UTIs in older men.

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10
Q

What is asymptomatic bacteriuria?

A

Microbiologic evidence for UTI in the absence of associated symptoms

More common in women and increases with age; screening is recommended in pregnancy.

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11
Q

What is the first-line treatment for acute uncomplicated UTI using fosfomycin tromethamine?

A

Single 3 g dose

It is effective and does not show cross-resistance with other antimicrobials.

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12
Q

What are the risks associated with fluoroquinolone use in treating UTIs?

A
  • Development of bacterial resistance
  • Serious adverse effects

Fluoroquinolones should be reserved for cases without alternative treatment options.

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13
Q

What is the recommended duration for nitrofurantoin treatment in uncomplicated UTI?

A

5 days

Nitrofurantoin is effective and well-tolerated for this duration.

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14
Q

What is the role of increased water intake in UTI management?

A

May decrease the risk of UTI recurrence

Clinical trials have shown poor quality, and further study is needed.

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15
Q

What is the recommended therapy for severe pyelonephritis?

A
  • Aminoglycoside IV ± ampicillin IV for initial therapy
  • Ciprofloxacin or levofloxacin IV × 10–14 days
  • Third-generation cephalosporin IV × 10–14 days

Treatment should be tailored based on the infecting uropathogen and local resistance patterns.

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16
Q

What is the risk associated with cephalosporins in relation to vulvovaginal candidiasis?

A

Greater likelihood

Cephalosporins may lead to an increased risk of vulvovaginal candidiasis.

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17
Q

Name three third-generation cephalosporins effective for parenteral treatment of pyelonephritis.

A
  • Ceftriaxone
  • Cefotaxime
  • Ceftazidime

These agents are used for treating pyelonephritis effectively.

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18
Q

Amoxicillin is not recommended for empiric therapy of uncomplicated UTI because it is less effective than other agents. True or False?

A

TRUE

Amoxicillin should be reserved for specific cases where the infecting organism is known to be susceptible.

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19
Q

What are the common side effects associated with amoxicillin/clavulanate?

A
  • Substantial GI side effects (10–25% incidence)

This medication may cause significant gastrointestinal issues.

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20
Q

Aminoglycosides are the therapy of choice for acute pyelonephritis requiring parenteral therapy. Name three aminoglycosides.

A
  • Amikacin
  • Gentamicin
  • Tobramycin

These agents are effective against most gram-negative organisms.

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21
Q

What are risk factors for infection or colonization with ESBL-producing organisms?

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A
  • Recent hospitalization
  • Residence in a long-term care facility
  • Prolonged use of broad-spectrum antibiotics
  • Travel to endemic countries

These factors increase the likelihood of encountering resistant organisms.

22
Q

Carbapenems are useful in treating severe UTI due to susceptible extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. True or False?

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A

TRUE

They are effective against specific resistant strains.

23
Q

What are the common adverse effects of carbapenems?

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A
  • Nausea
  • Vomiting
  • Diarrhea
  • Rash
  • Thrombophlebitis

These side effects are more common than serious allergic reactions.

24
Q

Cranberry products should not be recommended for the prevention of UTI due to conflicting evidence. True or False?

Study These Flashcards
A

TRUE

Clinical trials have not consistently supported their efficacy.

25
Asymptomatic bacteriuria refers to the presence of bacteria in urine at a concentration of _______ in the absence of symptoms.
≥108 cfu/L ## Footnote It is common but should not be treated except in specific cases like pregnancy.
26
Recurrent urinary tract infection (rUTI) is defined as **≥2 episodes** of acute cystitis within how many months?
6 months ## Footnote This definition helps in managing and treating recurrent cases.
27
What is **post-coital prophylaxis** in the context of recurrent UTIs?
Intermittent antibiotic therapy after sexual intercourse ## Footnote This approach may help prevent UTIs associated with sexual activity.
28
Long-term, low-dose prophylaxis for recurrent UTIs may include which two antibiotics?
* Nitrofurantoin (50–100 mg once daily) * Sulfamethoxazole/trimethoprim (200/40 mg once daily) ## Footnote This strategy is typically used for 6–12 months.
29
What should be the **preferred empiric therapy** for treating pyelonephritis in pregnancy?
Ceftriaxone ## Footnote This antibiotic is recommended for its effectiveness in pregnant patients.
30
Which antibiotics are considered **compatible with breastfeeding**?
* Fluoroquinolones * Nitrofurantoin * SMX/TMP * Amoxicillin * Cephalosporins ## Footnote These medications are deemed safe for nursing mothers.
31
Antimicrobial prophylaxis is effective to prevent recurrent symptomatic or asymptomatic UTIs in pregnant patients. True or False?
TRUE ## Footnote Nitrofurantoin and cephalexin are preferred for this purpose.
32
Healthy, nonpregnant women should not be screened or treated for **asymptomatic bacteriuria**. True or False?
TRUE ## Footnote Screening and treatment do not provide benefits in this population.
33
What is the recommended **duration of therapy** for acute uncomplicated UTI in women?
* 5-day course of nitrofurantoin * 3-day course of sulfamethoxazole/trimethoprim or trimethoprim ## Footnote These durations are preferred for effective treatment.
34
Fluoroquinolones should be reserved for cases where no other antimicrobial is suitable. True or False?
TRUE ## Footnote They are associated with serious adverse effects.
35
What is the **drug class** of **ciprofloxacin**?
Fluoroquinolones ## Footnote Ciprofloxacin is available in both oral and intravenous forms.
36
What are the **oral dosages** for **ciprofloxacin**?
* Immediate-release: 250–500 mg Q12H PO * Long-acting: 500–1000 mg Q24H PO ## Footnote Ciprofloxacin is used for various infections but has significant side effects.
37
List some **adverse effects** of **ciprofloxacin**.
* Abdominal pain * Nausea * Vomiting * Photosensitivity * Dizziness * Headache * Drowsiness * Insomnia * Diarrhea * Pseudomembranous colitis ## Footnote Potential adverse effects on developing cartilage; avoid in children and in pregnancy.
38
True or false: **Fluoroquinolones** are recommended for patients with acute uncomplicated UTI.
FALSE ## Footnote The adverse effects outweigh benefits; reserved for when alternative treatments are unavailable.
39
What can reduce the **absorption** of **fluoroquinolones**?
* Iron * Antacids * Sucralfate ## Footnote These substances can interfere with the effectiveness of fluoroquinolones.
40
What is the **drug class** of **trimethoprim**?
Folate Antagonists ## Footnote Trimethoprim is often used in combination with sulfamethoxazole.
41
What are the **adverse effects** of **trimethoprim**?
* Rash * Pruritus * Hyperkalemia ## Footnote Risk of hyperkalemia is increased in elderly and renally impaired patients.
42
What is the **oral dosage** for **nitrofurantoin macrocrystals**?
50–100 mg Q6H PO ## Footnote Long-term use can lead to pulmonary and hepatic toxicity.
43
What are the **adverse effects** of **amoxicillin**?
* Hypersensitivity reactions * Rash * Nausea * Vomiting * Pseudomembranous colitis * GI effects ## Footnote Amoxicillin may decrease the efficacy of oral contraceptives.
44
What is the **drug class** of **sulfamethoxazole/trimethoprim (SMX/TMP)**?
Sulfonamide Combinations ## Footnote SMX/TMP is commonly used for various bacterial infections.
45
What are some **adverse effects** of **sulfamethoxazole/trimethoprim (SMX/TMP)**?
* Rash * Pruritus * Hyperkalemia * Nausea * Vomiting * Diarrhea * Neutropenia * Thrombocytopenia * Anemia * Agranulocytosis ## Footnote Monitor serum potassium and renal function if used with ACE inhibitors and ARBs.
46
What is the **oral dosage** for **norfloxacin**?
400 mg Q12H PO ## Footnote Norfloxacin is another fluoroquinolone with similar side effects.
47
What is the **IV dosage** for **levofloxacin**?
500 mg Q24H IV ## Footnote Levofloxacin is used for various infections and has similar side effects to other fluoroquinolones.
48
What is the **IV dosage** for **ampicillin**?
1 g Q6H IV ## Footnote Ampicillin is a penicillin antibiotic with hypersensitivity reactions as a common side effect.
49
What is the **oral dosage** for **amoxicillin/clavulanate**?
* 500 mg Q8H PO * 875 mg Q12H PO ## Footnote This combination is used to overcome bacterial resistance.
50
What is the **cost** range for **piperacillin/tazobactam**?
$60–80 ## Footnote This combination is often used in severe infections.
51
What is the **oral dosage** for **fosfomycin tromethamine**?
One 3 g sachet × 1 dose ## Footnote Fosfomycin is used for uncomplicated urinary tract infections.
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