UTI

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  1. Acute Uncomplicated Cystitis Microorganisms
    • • Escherichia coli-80-90% of cases
    • • Proteus mirabilis
    • • Klebsiella pneumoniae
    • • Staphylococcus sapropyticus
    • • Enterococcus faecalis
  2. First Line Tx of Acute Uncomplicated Cystitis
    • • Nitrofurantoin monohydrate/macrocrystals (macrobid)
    • → 100mg PO BID x 5 days
    • • Trimethoprim-sulfamethoxazole 160/800mg (TMP/SMX or bactrim)
    • → 1 DS tab PO BID x 3 days
    • • Fosfomycin 3g x 1 dose
  3. Acute Uncomplicated Cystitis Caveats
    • • DO NOT USE BACTRIM IF RESISTANCE PREVALENCE IS KNOWN TO EXCEED 20%
    • • OR IF USED FOR UTI IN PREVIOUS 3 MONTHS
  4. Second Line Tx of Acute Uncomplicated Cystitis
    • • Fluoroquinolone
    • → Ciprofloxacin 250 mg PO BID x 3 days
    • → Cipro XR 500 mg PO Daily x 3 days
    • → Levofloxacin 250 mg PO Daily x 3 days
    • • Β-lactams (Avoid Ampicillin or Amoxicillin Alone)
    • → Amoxicillin-clavulanate
    • → Cefdinir
    • → Cefaclor
    • → Cefpoxime x 3-7 days
  5. Phenazopyridine
    • • Pyridium/Azo-Standard/Uristat
    • • Urinary analgesic
    • • 200 mg TID limit 1-2 days
    • • May mask non-responders to therapy
  6. UTIs in Pregnancy
    • • Tx for 7 days
    • • First line
    • → Amoxicillin-clavulanate 500mg PO q8h
    • → Cephalexin 500mg PO BID
    • • Alternatives
    • → Trimethoprim- avoid in first trimester
    • → Sulfamethoxazole- avoid in 3rd trimester
    • → Fluoroquinolones- category C
    • • Avoid tetracycline- fetal teeth discoloration
  7. Complicated UTI Risk Factors
    • • Indwelling urinary catheter
    • • Lack of circumcision in men
    • • Recent urinary instrumentation or surgical procedure (e.g. TURP)
    • • Benign prostatic hyperplasia (BPH)
  8. Complicated UTI Microorganisms
    • • Escherichia coli (50% of cases)
    • • Klebsiella pneumoniae
    • • Proteus mirabilis
    • • Pseudomonas aeruginosa
    • • Enterococcus faecalis
    • • Serratia marcescens
    • • Candida species
  9. Complicated UTI First Line Tx (Mild-Moderate Pyelonephritis)
    • • Fluoroquinolone (USE IF PREVALENCE OF RESISTANCE IS ≤10%)
    • → Ciprofloxacin 500mg PO BID x 7 days ± initial 400mg IV dose
    •     ¤ Alternate dosing- Cipro XR 1000mg PO daily x 7
    • → Levofloxacin 250mg PO x 10d
    •     ¤ Alternate dosing- 750mg PO x 5d
    • • Oral TMP/SMX 160/800mg 1 DS tab BID x 14 days
    •     ¤ High rate of resistance
    •     ¤ Poor choice for empiric Tx
    • • Aminoglycoside (one time dose then step down to PO)
    • → Gentamicin 5-7mg/kg dose
  10. Complicated UTI First Line Tx (Mild-Moderate Pyelonephritis: β-lactams)
    • • β-lactam antibiotic (3rd generation cephalosporin)
    • → Ceftriaxone 1g IV q 24h
    • → Ceftazidime 500mg IV q 8 hr
    • → Cefepime 1g q 8 hr
    • • β-lactam/β lactamase combination
    • → Piperacillin/tazobactam 3.375g IV q6h or 4.5g IV q8h
    • → Ticarcillin/clavulanate
    •     ¤ <60 kg: 200-300 mg ticarcillin/kg/day in divided doses Q4-6H (max= 18 g/day)
    •     ¤ ≥60 kg: 3.1 g Q4-6H
    • • β lactam antibiotic (Carbapenem)
    • → Meropenem 1g IV q 8 hr (500mg IV q 8 hr)
    • → Imipenem/cilastatin 500mg IV q 6 hr
    • → Doripenem 500mg IV q 8 hr x 10-14days
    • → Ertapenem 1g IV q 24 h (does not cover pseudomonas)
    • • β lactam antibiotic (Amino-PCN)
    • → Caution empiric use due to resistance but if susceptible may be used as stepdown therapy
    • • β lactam antibiotic (Monobactam)
    • → Reserve for true PCN allergic patients that may not tolerate carbapenems
Author:
ebmalonzo
ID:
316181
Card Set:
UTI
Updated:
2016-02-21 15:05:52
Tags:
UTI
Folders:
ID 1
Description:
ID 1 (Final): UTI
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