Therapeutics - UTI 1
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What constitutes a “Lower” UTI?
Cystitis (bladder) and urethritis
What constitutes an “Upper” UTI?
What constitutes a “Simple” UTI?
No structural or functional abnormality
What constitutes a “Complicated” UTI?
Presence of predisposing condition (congenital, catheter, stone, BPH, etc.)
Is lower or upper UTI simpler to treat?
Lower (Upper = pyelonephritis)
What are the risk factors for UTI?
- Age (young and old in men, throughout life in women)
- Anatomical abnormalities
- Mediations (Diuretics, newer diabetes medications, Anticholinergics)
What are the common organisms implicated in community acquired UTIs?
- E. coli
- Proteus mirabilis
- Staph saprophyticus
What are the common organisms implicated in Hospital acquired UTIs?
- Enterococcus faecalis
- Pseudomonas aeruginosa
- E. coli
- Staphylococcus a.
What drug is a good choice for a nursing home patient with a UTI?
Flouroquinolones (Cipro/Levo, etc.)
An ESBL E. coli will typically be resistant to what usual UTI treatments?
Cephalosporins, PCNs, flouroquinolones and aminoglycosides
ESBL producing E. coli will typically be susceptible to what antibiotics?
What are the clinical manifestations of UTI without pyelonephritis?
What are the clinical manifestations of UTI with pyelonephritis?
- Flank pain
- Abdominal pain
- Mental status changes
How is UTI diagnosed?
- Urinalysis (nitrites, WBCs, WBC esterases)
- Positive culture from urinalysis
What constitutes uncomplicated UTI?
- No co-morbidities
- No known urologic problems
- Not pregnant
What constitutes a complicated UTI?
- Hx of childhood UTIs
- Pre-adolescent or Post-menopausal
- Underlying metabolic disorder
- Urologic abnormality
What are the indications for a single dose therapy for UTI?
- Lower UTI
What are the CIs for single dose treatment of UTIs?
What treatment is offered for Single dose UTI therapy?
Fosfomycin tromethamine (Monurol)
What is the dosing for Fosfomycin tromethamine (Monurol)?
1 x dose of 3 grams powder packet dissolved in water
What is the most common SE for fosfomycin tromethamine (Monurol)?
What is the brand name for fosfomycin tromethamine?
What is the generic name for Monurol?
What is the main disadvantage to Fosfomycin tromethamine (Monurol)?
$70 a dose
How should you take Fosfomycin tromethamine (Monurol)?
Dissolved in water on an empty stomach
What are the indications for a 3 day therapy for the treatment of UTI?
- Healthy men ages 20-40
- Girls over 5 years w/symptoms
- Healthy non-pregnant women with first or second episode
What are the drugs of choice for 3 day treatment of UTI?
- Quinolone (Cipro/Levo)
- Nitrofurantoin macrocrystals
What is the dose for UTI 3 day treatment with TMP/SMX?
4 mg/kg trimethoprim Q12H x3 days
What is the dose for UTI 3 day treatment with Ciprofloxacin?
250 mg PO BID x3 days
What is the dose for UTI 3 day treatment with Levofloxacin?
250 mg PO QD x3 days
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