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89 Cards in this Set
- Front
- Back
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Are men or somen more vulnerable to UTIs?
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Women!
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What is the definition of relapse in the setting of a UTI?
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UTI due to the same bug <2 weeks after end of tx.
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What is the definition of reinfection in the setting of a UTI?
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UTI due to a different microbe > 2 weeks after the end of treatment
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What are the most common bacteria causing uncomplicated UTIs?
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E. coli: 70-95%
Staphylococcus saprophyticus: 5-20% if it's a UTI think E-COL-I! |
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What are causes of complicated UTIs?
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85%: CATHETER ASSOCIATED!
Other causes: Urologic abnormalities Renal, prostatic infection Resistant infections |
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What bacteria commonly cause complicated UTIs?
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E. coli: 20-54%
Klebsiella Enterobacter Pseudomonas |
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What drugs are UTI bugs resistant to?
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Ampicillin!
Fluoroquinolones: low, but increasing |
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Where is resistance to ampicillin highest in UTI bacteria? Lowest?
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Highest: western US
Lowest: NE US Downhill resistance from W-->NE |
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What is the "superdrug" for UTIs?
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Nitrofurantoin
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What type of bacteria are resistant to the fluoroquinolones? What type of resistance do they have/
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Non E-coli
Intermediate resistance |
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What are the first line drugs in acute uncomplicated cystitis in women?
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Trimethoprim-Sulfamethoxazole
Nitrofurantoin |
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What are the second line drugs in acute uncomplicated cystitis in women?
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Fosfomycin
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If you can't use 1st or 2nd line drugs for acute uncomplicated cystitis in women, what should you use?
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B-lactam with a beta lactamase inhibitor
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Should you perform susceptibility testing for women with acute uncomplicated cystitis?
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No.
Treat empirically, see if the infection resolves. If not, then you teest and see what will work. |
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What are the first two things that you should do when a women comes in with acute uncomplicated pyelonephritis?
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1. Urine culture
2. Drug susceptibility testing |
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What are the first line drugs in acute uncomplicated pyelonephritis in women?
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Fluoroquinolone
TMP-SMX for susceptible organisms |
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If a woman needs hospitalization for acute pyelonephritis, what do we use for treatment?
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IV:
Fluoroquinolone, aminoglycoside +/- ampicillin, extended spectrum cephalosporin OR penicillin +/- aminoglycoside |
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Why do we prescribe aminoglycosides and beta lactam drugs together?
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We need the synergy!
One drug gets rid of the cell wall, the other goes in for the kill!! |
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What is the desired pharmacokinetic parameter for all drugs for uncomplicated UTIs?
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High concentration of the drug in the urine!
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What is the mechanism of the sulfonamides?
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Inhibition of dihydropteroate synthase
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What is the mechanism of trimethoprim?
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Inhibition of dihydrofolate reduction
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Generally, what pathway does TMP-SMX act on?
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Folate synhase
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What is the mechanism of resistance to TMP?
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Overproduction of DHFR
Alteration of DHFR to prevent binding of TMP |
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What is the mechanism of resistance to SMX?
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Overproduction of PABA (reagent for DHPS)
Alteration of DHPS |
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Is TMP-SMX bacteriostatic/cidal?
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Static
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What is the elimination of TMP-SMX?
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Renal
High concentrations in the urine |
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What are the adverse effects of TMP-SMX?
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GI irritation
Hematologic toxicity in people with G6PD Rash Bad reactions with: warfarin, anticonvulsants, tolbutamide |
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How long should you treat someone with an uncomplicated UTI?
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3 days
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How long should you treat someone with an acute uncomplicated pyelonephritis?
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14 days
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What is the mechanism of Nitrofurantoin? Is it bacteriostatic/cidal?
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DNA double strand breaks
Cidal |
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What bacteria is nitrofurantoin useless against?
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Bugs of complicated UTIs
Enterobacter, proteus, klebsiella Pseudomonas |
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Where does nitrofurantoin achieve active concentrations?
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Urine
Not in the body --> eliminated rapidly from the body |
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What are the adverse effects of nitrofurantoin?
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Fat Albert symptoms
GI irritation Hemolytic anemia in px. with G6PD deficiency Pulmonary rxns. (acute, chrnoc) Neurologic problems |
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Should you use Nitrofurantoin in complicated or uncomplicated UTIs?
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Uncomplicated
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How long should you use nitrofurantoin?
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7 days
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What is the mechanism of fosfomycin?
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Beta lactam inhibitor
Inhibitor of phosphoenolpyruvate synthetase in bacterial cell wall synthesis CIDAL |
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What are the mechanisms of resistance to fosfomycin?
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Chromosomal: decreased uptake into the bacteria
Plasmid: enzymatic conjugation to glutathione |
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How is fosfomycin administered?
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Orally
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Where does fosfomycin distribute?
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All over the body
CSF |
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What is the excretion of fosfomycin?
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9%% renally
As unchanged drug |
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What are the adverse effects of fosfomycin?
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GI distress
CNS problems Vaginitis Rash Asthenia |
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What is the dosing of fosfomycin?
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1 3g dose dissolved in water
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Should you use fosfomycin to treat for pyelonephritis?
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No.
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What is the mechanism of fluoroquinolones?
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Cause dsDNA breaks due to locking in Topo, Gyrase in the active conformation after forming the break
Cidal |
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What are the mechanisms of resistance to DNA gyrase, Topo?
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Efflux of the drug
Mutations of Gyrase, Topo IV |
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What bacteria are fluoroquinolones active agasint/
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Gram positive, negative
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What types of fluoroquinolones achieve higher tissue concentrations?
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Cipro, levo do better than moxi
They're preferred |
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What are the adverse effects of the fluoroquinolones?
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Flo side effects
GI irritation CNS Hypersensitivity Tendon ruputre Cartilage damage Photosensitivity |
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What are the clinical uses of the fluoroquinolones?
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Women with acute, uncomplicated pyelonephritis
Cystitis in px. who can't use TMP-SMX |
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What antibiotics are to be used for complicated UTIs?
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Oral:
Fluoroquinolones Amoxicillin Parenteral drugs: Piperacillin + tazobactam Ceftriaxone Aminoglycosides |
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What are the main mechanisms of resistance to beta lactams?
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Beta lactamases
Alterations of PBPs Acquiring new PBPs |
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In what types of UTIs should you use amoxicillin + clavulanate or piperacillin+tazobactam?
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Gram + organisms
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What is the mechianism of amoxicillin?
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Binding of A-K in bacterial cell walls
Cidal |
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What are the adverse reactions to amoxicillin+clavulanate/piperacillin + tacobactam?
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GI irritation
Rash Anaphylaxis |
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What are the main mechanisms of resistance to beta lactams?
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Beta lactamases
Alterations of PBPs Acquiring new PBPs |
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What is more effective: amoxicillin-clavulanate or cipro?
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Cipro
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In what types of UTIs should you use amoxicillin + clavulanate or piperacillin+tazobactam?
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Gram + organisms
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How is amoxacillin-clavulanate administered?
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Orally
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What is the mechianism of amoxicillin?
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Binding of A-K in bacterial cell walls
Cidal |
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How is piperacillin+tazobactam administered?
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Parenterally
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What are the adverse reactions to amoxicillin+clavulanate/piperacillin + tacobactam?
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GI irritation
Rash Anaphylaxis |
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What kinds of bacteria does ceftriaxone mainly have activity against?
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Gram negatives
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What is more effective: amoxicillin-clavulanate or cipro?
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Cipro
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Is ceftriaxone susceptible to beta lactamases?
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NO!
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How is amoxacillin-clavulanate administered?
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Orally
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What is the administeration of ceftriaxone?
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Parenterally
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How is piperacillin+tazobactam administered?
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Parenterally
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What kinds of bacteria does ceftriaxone mainly have activity against?
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Gram negatives
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Is ceftriaxone susceptible to beta lactamases?
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NO!
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What is the administeration of ceftriaxone?
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Parenterally
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What are the adverse effects of ceftriaxone?
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GI
Rash Anaphylaxis |
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What is the mechanism of the aminoglycosides?
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Inhibition of bacterial protein synthesis by binding to the 30S ribosome
Cidal |
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What is the mechanism of resitance to aminoglycosides?
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Alteration of the drug (phosphorylation, acetylation, adenylation) so that it no longer binds to the 30S ribosome
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What is the administeration of the aminoglycosides?
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Parenterally
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What are the adverse effects of the aminoglycosides?
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Amman side effects
Ototoxicity: auditory and vestibular Nephrotoxicity Teratogenic |
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If a woman has recurrent UTIs, what should she do?
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Take prophylaxis:
Daily After sex |
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Is cranberry juice effective in the treatment of UTIs?
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Not enough evidence to support this
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What sex does S. saprophyticus cause UTIs in?
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Women
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Should you use nitrofurantoin in men?
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No.
It's not effective for their kind of UTIs |
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How long should you use TMP-SMX in men?
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7 days instead of 3
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What bacterial is most causative of UTIs in children?
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E. coli
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Other than E. coli, what bugs cause UTIs in children?
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Klebsiella
Proteus Enterobacter S. saprophyticus |
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What are the recommended antibiotics for oral therapy in kdis?
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3rd generation cephalosporins
Amoxicillin + clavulanate |
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What are the recommended IV antibiotics for UTIs in kids?
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2nd, 3rd generation cephalosporins
Aminoglycosides |
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If there's a UTI shortly after a catheter is put in, what bug should you think?
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E. coli
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If there's a UTI a long time after a catheter is put in, what should you think?
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More exotic organisms:
E. coli Proteus |
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In what situations do you see fugal UTIs occurring?
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Catheter has been put in
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If someone has a catheter associated UTI, what drugs should we use?
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Gram negatives:
3rd generation cephlaosporin Fluoroquinolone Gram positie: Vanco |
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How long should you treat someone who has a catheter associated UTI?
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7-14 days
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