Therapeutics - Bacterial Prostatitis/UTIs
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What are the pathogens of bacterial prostatitis?
- Pseudomonas spp.
- Proteus mirabilis
- Klebsiella pneumoniae
- Neisseria gonorrhea
How long is the treatment course for bacterial prostatitis?
prolonged antibiotic course (4-12 weeks)
What are the DOC for bacterial prostatitis?
Quinalones or tmp/smx are drugs of choice
Are quinalones recommended for treatment of N gonorrhea bacterial prostatitis?
What are the advantages of Bactrim for UTIs?
- available in variety of dosage forms
- twice daily dosing
- relatively well tolerated
What are the disadvantages of Bactrim for UTIs?
- allergic reactions which may be life threatening
- IV dosing is confusing
- should be avoided during last trimester of pregnancy
- dosage adjustment with renal impairment
What are the advantages of Quinalones for UTIs?
- excellent gram negative activity
- available both oral and IV
- oral bioavailability ~ IV
- once-twice daily dosing
- superior prostatic tissue penetration
What are the disadvantages of Quinalones for UTIs?
- CI in children and pregnancy
- many significant drug interactions
- adjust dosage with renal impairement
What interactions are common with Quinalones?
- Warfarin - prolonged bleeding time
- Theophylline - elevated serum theophylline levels
- Caffeine - insomnia, jitteriness
- Calcium, aluminum and iron - dramatic decrease in absorption if taken at the same time
What are the advantages of ampicillin and amoxicillin in the treatment of UTIs?
- well tolerated
- effective against Enterococci
- safe for use during all phases of pregnancy and pediatrics
What are the disadvantages of ampicillin and amoxicillin in the treatment of UTIs?
- developing resistance
- 10% of population is allergic
- TID dosing frequency
What are the advantages of aminoglycosides in the treatment of UTIs?
- excellent efficacy against all gram negative organisms
- generally well tolerated
What are the disadvantages of aminoglycosides in the treatment of UTIs?
- renal and ototoxicity
- difficult dosing
- serum concentration monitoring required
- not available orally
What are the advantages of cephalosporins in the treatment of UTIs?
- good to excellent coverage against MOST gram negative pathogens
- easily dosed
- very well tolerated
- available oral and parenteral
What are the disadvantages of cephalosporins in the treatment of UTIs?
- not reliable with short course therapy
- no activity against enterococcus
- no oral agent effect against Pseudomonas aer.
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