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Second Chance Exam - UTI

Signs of fever/chills, flank pain, or vomiting are indicative of:
Cystitis
Pyelonephritis
What is the most common cause of UTIs
E. Coli
Proteus
Klebsiella
Enterobacter
Staph saprophyticus
What is a possible empiric antibiotic therapy for patients with no allergies?
Ciprofloxacin 250 mg PO Q 12 hours x 3 days
Amoxicillin 500 mg PO Q 8 hours x 7 days
Nitrofurantoin 100 mg PO Q 12 hours x 5 days
Levofloxacin 500 mg IV Q 24 hours x 3 days
What are some pro's of using nitrofurantoin? (MULTI ANSWER)
Good coverage for common gram positive and negative urinary pathogens including E. coli
No systemic absorption
Low collateral damage
Can treat pyelonephritis
What are some con's of using nitrofurantoin? (MULTI ANSWER)
Can not treat pyelonephritis
Drug can not concentrate well into the urine with CrCl < 50
Systemic absorption
High collateral damage
What are some pro's of using Bactrim? (MULTI ANSWER)
Good activity against common urinary pathogens
Able to penetrate into both lower and upper urinary tract
Low propensity for collateral damage (compared to fluoroquinolones)
No resistance
What are some con's of using Bactrim? (MULTI ANSWER)
Increasing resistance
Should not be used empirically when local resistance > 20%
Cannot penetrate into both lower and upper urinary tract
High collateral damage
What are some pro's of Fosfomycin? (MULTI ANSWER)
Single dose treatment
Maintains activity against many resistant urinary pathogens
No systemic absorption
Low collateral damage
Can treat pyelonephritis
What are some con's of Fosfomycin? (MULTI ANSWER)
Can not treat pyelonephritis
High drug cost
Clinically inferior to Bactrim
Systemic absorption
High collateral damage
What are some pro's of FQs? (MULTIPLE ANSWER)
Able to penetrate into both lower and upper urinary tract (Ciprofloxacin and levofloxacin only)
XR formulations allow for once daily dosing
Broad spectrum of activity including common urinary pathogens
No renal dosing
Low collateral damage
What are some con's of FQs? (MULTI ANSWER)
Cannot penetrate lower and upper urinary tract
No broad spectrum activity
Increased resistance
Renal dosing
High collateral damage
What are some pro's for using beta-lactams? (MULTI ANSWER)
Empiric use of broad spectrum cephalosporins for pyelonephritis
Narrow spectrum cephalosporins low collateral damage
Oral cystitis option more effective than Bactrim
What are some con's for using beta-lactams? (MULTI ANSWER)
Broad spectrum cephalosporins high collateral damage
Increasing rates of ESBL producing organisms
Oral cystitis options less effective than TMP-SMX and fluoroquinolones
Cannot be used empirically
What are some options for pyelonephritis? (MULTI ANSWER)
Cipro 500mg PO BID x 7D
Cipro XR 1000 QD x 7d
Levo 750mg qd x 5d
Bactrim DS PO BID x14d
Beta-lactam x 10-14D
Cipro 500 QD x 7d
Levo 500mg po qd x 5d
When susceptibility unknown or FQ resistance known to be >10% use:
Cephalexin
Cetriaxone 1g IV
AG
Levofloxacin
What can be used with hx ESBL E. Coli for empiric treatment?
Vancomycin
Meropenam
Cephalexin
Levofloxacin
How long should treatment last for complicated UTI?
5 days
7 days
9 days
14 days
What drugs should be avoided in pyelonephritis? (MULTI ANSWER)
Fosfomycin
Nitrofurantoin
Cephalosporins
Beta-lactams
Bactrim
 
 
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