UTIs

Question 1

What are the DOC for acute cystitis?

Answer 1

nitrofurantoin 100mg PO BID x5 days (contraindicated if CrCl <60mL/min)
or
SMX/TMP DS 1 tab PO BID x3 days (do NOT use if sulfa allergy)
or
fosfomycin 3g PO x1 dose
or
pivmecillinam 185mg PO TID x3-7 days

Question 2

What are alternative options for acute cystitis treatment?

Answer 2

beta-lactam (amoxicillin/clavulanate or cephalosporin) x5-7 days
or
ciprofloxacin 250mg PO BID x3 days
or
levofloxacin 250mg PO daily x3 days

Question 3

Do not use which quinolone for UTIs?

Answer 3

moxifloxacin (does not reach high levels in urine)

Question 4

What is prophylactic treatment for acute cystitis?

Answer 4

if ≥3 episodes in 1 year: SMX/TMP SS 1tab daily, nitrofurantoin 50mg daily, or SMX/TMP DS 1tab after sexual intercourse

Question 5

What is the last line option for acute cystitis?

Answer 5

solupenem/probenecid (orlynvah)

Question 6

What is the DOC for acute pyelonephritis for moderately ill outpatient? - if local quinolone resistance ≤10%

Answer 6

ciprofloxacin 500mg PO BID x5-7 days
or
levofloxacin 750mg PO daily x5-7 days

Question 7

What is the DOC for acute pyelonephritis for moderately ill outpatient? - if local quinolone resistance >10%

Answer 7

ceftriaxone 1g IV/IM x1 or
ertapenem 1g IV/IM x1
or
aminoglycoside extended interval dose IV/IM x1, then continue with quinolone x5-7 days
concern for quinolone AEs: SMX/TMP or beta-lactam (amoxicillin/clavulanate, cefdinir, cefadroxil, or cefpodoxime) x7-10 days

Question 8

What is the DOC for acute pyelonephritis for severely ill hospitalized pts?

Answer 8

initial: ceftriaxone or quinolone (ciprofloxacin or levofloxacin)
concern for resistance: piperacillin/tazobactam or a carbapenem (if ESBL-producing organism suspected)
duration: 5-10 days

Question 9

What is the treatment for acute pyelonephritis if risk for pseudomonas infection?

Answer 9

piperacillin/tazobactam
or
antipseudomonal carbapenem (meropenem, doripenem, imipenem/cilastatin)

Question 10

What is the last line option for acute pyelonephritis?

Answer 10

cefiderocol
imipenem/cilastatin/relebactam
meropenem/vaborbactam
plazomicin

Question 11

What is the urinary analgesic we use?

Answer 11

phenazopyridine
200mg PO TID x2 days (max)
take with 8oz water and with food to minimize stomach upset

Question 12

What are the contraindications of phenazopyridine?

Answer 12

pts with renal impairment or liver disease

Question 13

What can phenazopyridine cause?

Answer 13

red-orange coloring of the urine and other body fluids, contact lenses/clothes can be stained

Question 14

Asymptomatic bacteriuria in pregnancy - treatment

Answer 14

beta-lactams preferred: amoxicillin +/- clavulanate or an oral cephalosporin (cephalexin)
beta-lactam allergy: nitrofurantoin, SMX/TMP, fosfomycin

Question 15

American College of Obsetricians and Gynecologists suggesting avoiding what in pregnant women?

Answer 15

avoid nitrofurantoin and SMX/TMP in 1st trimester (SMX/TMP can cause hyperbilirubinemia or kernicterus)
nitrofurantoin can cause hemolytic anemia in the baby if used in the 3rd trimester