Pharm 540 Uti

Front 1

Definition of a UTI

Back 1

Presence of urinary microorganisms not due to contamination, with potential to invade UT tissues.

Front 2

True or False?
Diagnosis of a UTI can be made on the presence of bacteria alone?

Back 2

False. Diagnosis of UTI is NOT made on presence of bacteria alone.

Front 3

UTI's are most common in whom?

Back 3

UTI's are most common bacterial infection in adults.
More common in females.

Front 4

Define Acute Pyelonephritis, and give signs and symptoms

Back 4

Inflammation of kidney with s/sx of flank pain, tenderness, bacteruria, pyuria, and fever.

Front 5

Define Chronic pyelonephritis

Back 5

Chronic inflammatory condition of kidney associated with cortical scarring and dilation.

Front 6

What amount of bacteria in urine represents infection in females?

Back 6

> or equal to 10^5 bacteria/mL typically represents infection.
In symptomatic females - 95% true bacteremia.
In asymptomatic females - 80% true bacteruria. Need to verify results with additional urine specimen.

Front 7

What amount of bacteria in urine represents infection in males?

Back 7

> or equal to 10^3 bacteria/mL in symptomatic males.

Front 8

What are the most common community-acquired UTI pathogens?

Back 8

E. coli (80-90%)
P. mirabilis
K. pneumoniae
E. faecalis
S. saprophyticus (most common in young sexually-active females)

Front 9

What are the most common hospital-acquired UTI pathogens?

Back 9

E. coli (<50%)
P. aeruginosa
Proteus sp.
Serratia sp.
Enterobacter sp.
Acinetobacter sp.
Enterococcus sp.

Front 10

What is the most common pathogen in patients wtih catheters who are receiving new antimicrobial treatment?

Back 10

Candida albicans

Front 11

List the predisposing factors of UTI's?

Back 11

Obstruction (BPH, tumors), Incomplete bladder emptying (anticholinergic drugs), urinary catheterization, pregnancy, sexual intercourse (promotes urethral colonization).

Front 12

S/Sx of Lower UTI/Cystitis?

Back 12

Dysuria, frequency and urgency of urination, suprapubic pain, usually no fever

Front 13

S/Sx of upper UTI/Pyelonephritis?

Back 13

Loin pain, tenderness, fever, chills, N/V, hematuria.

Front 14

List nonpharmacological treatment of UTI

Back 14

Cranberry products: juice, tablets, capsules (not proven to treat UTI, but can help to prevent recurrence).
Hydration - frequent bladder emptying.

Front 15

What class of agents are best for treatment of UTI?

Back 15

Want to choose an agent with high urinary concentrations - ANTIMICROBIALS - eliminated renally and are filtered and secreted into urine.

Front 16

Describe the different courses of treatment and their efficacies.

Back 16

Conventional - 7-14 days of antibiotic: best efficacy.
3-day treatment - more effective than single dose.
Single dose treatment - cure rates 65-100%

Front 17

When should the single dose treatment be used? When is it NOT appropriate?

Back 17

Only appropriate for simple UTI's. Cannot be used for pyelonephritis or male patients.

Front 18

List the drug of choice for lower UTI treatment in females with UTI's not associated with structural or neurologic abnormalities

Back 18

3-day Tx: TMP/SMX DS, Trimethoprim,or Nitrofurantoin (unless renally impaired).
Single dose Tx: Amoxicillin, TMP/SMX DS, Cefaclor, or Cephalexin.

Front 19

Who would you treat lower UTI?

Back 19

In females WITH signs and symptoms of lower UTI AND proven or highly probably bacteruria should be treated with antibiotics.

Front 20

What drug class should you avoid when treating lower UTI?

Back 20

FQ's

Front 21

What do you do when there is a treatment failure to TMP/SMX or nitrofurantoin in lower UTI?

Back 21

Need to check cultures.

Front 22

When should upper UTI's be treated?

Back 22

They should ALWAYS be treated, due to risk of bacteremia.

Front 23

Which agent is not effective in the treatment of upper UTI?

Back 23

Nitrofurantoin - doesnt achieve effective concentration in blood.

Front 24

True or false?
Always check urine cultures prior to starting treatment of upper UTI?

Back 24

TRUE.

Front 25

For how many days should treatment be for upper UTI?

Back 25

At least 7 days, many go til 14 days.

Front 26

What is the drug of choice for 'mild to moderate' upper UTI (acute pyelonephritis), and for how long?

Back 26

TMP/SMX, FQ (not moxifloxocin)for 14 days.

Front 27

In 'mild to moderate' upper UTI, what drug should you used if pathogen is Enterococcus?

Back 27

Ampicillin or Amoxicillin for 14 days.

Front 28

What are the drugs of choice in males with upper UTI? How long should you treat? How long to treat for recurrent upper UTI?

Back 28

Drug of Choice - FQ (not moxifloxacin).
Or can use TMP/SMX and augmentin.
Treat for 14 days. If recurrent, treat for up to 6 weeks (consider prostatitis).

Front 29

True or False?
If the patient is asymptomatic, you should treat anyway with bacturia.

Back 29

False. If patient is asymptomatic with bacturia, do NOT treat. Antibiotic prophylaxis is not recommended.

Front 30

What is the DOC for UTI from catheterization in patients with S/Sx of upper UTI? How long should you treat?

Back 30

Replace catheter prior to starting antibiotic.
Tx with FQ or augmentin for 7 days.

Front 31

What is the most frequenct pathogen in UTI during pregnancy?

Back 31

E. coli

Front 32

What is the treatment of UTI durig pregnancy? How long should you treat?

Back 32

Amoxicillin, Cephalexin, Nitrofurantoin, TMP/SMX. Treat for 7 days.

Front 33

When can you use TMP/SMX in pregnant women?

Back 33

ONLY in 1st and 2nd trimester!

Front 34

What drugs should you AVOID in pregnant women with UTI?

Back 34

FQ's and TCN (tricyclin)

Front 35

If the initial treatment fails in pregnant women with UTI, how much longer should you treat?

Back 35

Treat for an additional 7 days with same agent.

Front 36

True or false?
80% of recurrent UTI infections will be reinfected with a different organism, and 20% will be reinfected with the same organism.

Back 36

TRUE.

Front 37

For recurrent UTI infection, how long should you treat? If this fails also, what should you do?

Back 37

Re-treat for additional 14 days.
Treat additional 14 days (for a total of 6 weeks).

Front 38

If you treat UTI for total of 6 weeks and it is still recurring, what should you do?

Back 38

Complete urologic evaluation, consider obstruction and consider prophylactic treatment.

Front 39

After how many UTI's/year should you consider prophylactic UTI treatment?

Back 39

If > or equal to 3 UTI's/year

Front 40

If the recurrent UTI infections are related to sexual intercourse, how should you treat prophylactically and what drugs can you use?

Back 40

Post-coital single-dose treatment given after intercourse.
Can use Cephalexin, Nitrofurantoin, or TMP/SMX DS.

Front 41

If the recurrent UTI is caused by other causes and not related to intercourse, how should you treat and what drugs can you use?

Back 41

Low dose for 6-12 months.
Can use TMP/SMX SS, Trimethoprim, Cephalexin, Nitrofurantoin, FQ - either Ciprofloxacin or levofloxacin.