Term
| What pathogen usually causes uncomplicated cystitis? |
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Definition
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Term
| How many days should you treat uncomplicated UTIs? complicated? pyelonephritis? |
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Definition
Uncomplicated: 3 days
Complicated: 7 days
Pyelonephritis: 10-14 days |
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Term
| What are two instances of UTI when you should NOT treat? |
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Definition
| asymptomatic bacteriuria in the elderly and patients with indwelling catheters w/o symptoms of UTI |
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Term
| What are the first and second lines of treatment for cystitis? |
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Definition
1st: TMP-SMX DS bid for 3 days. Trimethoprim 100mg bid for 3 days if all to sulfa. 1st generation cephalosorin for 5 days.
2nd: nitrofurantoin 100mg qid for 5 days. ofloxacin 200mg bid for 3 days (other FQ may be used other than moxifloxacin) reserve for TMP-SMX resistant strains |
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Term
| How do you treat pyelonephritis? |
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Definition
| fluoroquinolones, TMP-SMX, aminoglycosides, 3rd gen cephalosporins |
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Term
| What is the dosage ratio of SMX-TMP? |
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Definition
5:1 ratio of SMX:TMP
Single strength (SS) = SMX 400mg: TMP 80mg
Double strength (DS) = SMX 800mg: TMP 160mg |
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Term
| What are 5 drugs besides abx that contain sulfonamide moiety? |
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Definition
| hydrochlorthiazide, furosemide (Lasix), glyuride, calecoxib (Cerebrex), sumatriptan (Imitrex) |
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Term
| Why is it okay for people with abx sulfa allergies to usually be able to take these other drugs? |
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Definition
| hypersensitivity to sulfonamide abx is due to metabolites specific only for the abx. Non-abx sulfonamide drugs have little cross reactivity. |
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Term
| When do you consider chronic UTI prophylaxis? |
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Definition
| if > 3 episodes of cystitis in a year |
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Term
| What is the course of treatment for prophylaxis of UTI? |
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Definition
give low, qd dose of abx (preferally TMP-SMX) for 6 months - 1 year.
Alternatives: TMP alone, fluoroquinolone if bacteria resistant to TMP-SMX, Nitrofurantoin |
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Term
| What is important to know about Nitrofurantoin when using it for UTI? |
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Definition
Nausea more common and must take with food.
Greater chance of long-term adverse effects such as pneumonitis or drug-induced liver injury.
Active against Enterococcus in urine unlike other agents. |
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Term
| What are some uses for urinary analgesics and 2 drugs in this category? |
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Definition
Symptomatic relief of pain, urgency, burning, and frequency associated with lower urinary tract mucosal inflam from infection.
1. Phenazopyridine (Pyridium) 200mg PO tid. colors urine and clothes, available OTC
2. Flavoxate (Urispas) 100-200mg PO tid to qid. anticholinergic adverse effects |
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Term
| What is the drug of choice for acute prostatitis? |
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Definition
TMP-SMX for 4 weeks.
Fluoroquinolones for gram-negative bacteria not sensitive to TMP-SMX |
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Term
| What is the treatment regimen for chronic prostatitis? |
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Definition
| TMP-SMX first choice, fluoroquinolones 2nd choice for 6-12 weeks |
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Term
| What are the usual suspects for intra-abd infections? |
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Definition
Gram-negative bacteria: E. coli, Proteus mirabilis, Enerobacter
Gram-positive: Enterococcus
Anaerobic bacteria (less common) |
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Term
| What are the abx of choice for anaerobic infections? |
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Definition
1. Metronidazole (Flagyl) - penetrates CNS, bactericidal, local anti-inflam activity in GI, ALCOHOL INTOLERANCE. 500mg tid for severe
2. Clindamycin - more adverse effects, including abx-associated diarrhea and potential C. diff
3. Penicillin/B-lactamase inhibitor combos - Oral: amoxicillin/clavulanate. IV: piperacillin/tazobactam (Zosyn) |
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Term
| What are the common bacteria that cause infection in the GI tract, respiratory, and skin? |
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Definition
GI: Bacteroides fragilis - common in distal bowel/colon. always assume present. C. diff - uncommon but can become superinfection. tx oral metronidazole, oral vancomycin
Respiratory: Peptostreptococcus - cause aspiration pna from inhalation of upper GI bacterial flora
Skin: Clostridium perfringes - cause gangrene |
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Term
| What are the recommended single agents for intra-abd infections? |
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Definition
Piperacillin-tazobactam: includes anaerobic activity.
Ertapenem: longer T1/2 than imipenem. most resistant B-lactam to extended-spectrum B-lactamases. no enterococcus or pseudomonas activity |
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Term
| What are the recommended combination agents for intra-abd infections? |
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Definition
*no enterococcus activity*
Ceftriaxone or cefotaxime plus metronidazole.
Levoflaxacin or moxifloxacin plus metronidazole.
Aztreonam plus metronidazole (no gram-positive infection) |
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Term
| What are 3 aminoglycoside abx and what are they used for? |
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Definition
Gentamycin, tobramycin, and amikacin.
Used in combo w/cephalosporins and quinolones for gram- infections, in particular Pseudomonas (synergistic). given IV or IM as single dose. concentration dependent killing. |
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Term
| What are the adverse effects of aminoglycoside abx? |
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Definition
| renal toxicity and ototoxicity |
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Term
| Why are aminoglycoside abx given as a single dose daily? |
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Definition
Less toxicity with peak dose of 20 ug/ml
Long post-abx effect |
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Term
| How do you treat a UTI caused by Pseudomonas Aeruginosa? |
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Definition
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Term
| How do you treat systemic infections caused by Pseudomonas Aeruginosa? |
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Definition
Piperacillin/tazobactam +/- tobramycin
Ceftazidime or cefepime +/- tobramycin
Imipenem or meropenem +/- tobramycin |
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Term
| How do you treat pulmonary infections caused by Pseudomonas Aeruginosa? |
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Definition
| same as systemic but always add aminoglycoside. inhaled tobra available for CF infections |
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Term
| When is pna considered hospital acquired? |
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Definition
| when it occurs 48hrs or more after hospital admission or endotracheal intubation |
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Term
| Osteomyelitis is usually secondary to what bacteria? |
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Definition
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Term
| How do you treat Chlamydia? |
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Definition
Azithromycin 1gm x 1 dose or Doxycycline 100mg PO bid x 7 days
Alternatives: Erythromycin 500mg PO qid x 7 days or Levofloxacin 500mg PO qd x 7 days |
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Term
| How do you treat Gonorrhea? |
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Definition
Ceftriaxone 125mg IM once (dose for gram- infections is 1-2gm)
Cefixime 400mg PO once
Fluoroquinolones not recommended |
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Term
| What causes nongonococcal urethritis and how do you treat it? |
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Definition
Ureaplasma urealyticum or Mycoplasma genitalium.
Usually responds to azithromycin or doxycycline |
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Term
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Definition
| 2/3 of cases caused by C. trachomatis or N. gonorrhea. Anaerobic bacteria also involved. Combination treatment necessary to treat all possible pathogens |
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Term
| What causes Trichomoniasis and how do you treat it? |
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Definition
Trichomonas vaginalis, an anaerobic protozoan.
Metronidazole (Flagyl) 2gm PO once |
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Term
| What causes bacterial vaginosis and how do you treat it? |
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Definition
Gardnerella vaginalis, Mycoplasma hominis, and various anaerobes.
Metronidazole (Flagyl) 500mg PO bid x 7 days
Metronidazole gel 0.75% intravaginally qd x 5 days |
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Term
| What causes Syphilis and how do you treat it? |
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Definition
Treponema pallidum, a spirochete.
Penicillin G benzathine 2.4mil units IM once for early stage, weekly x 3 for late stage.
Neurosyphilis: high dose penicillin G IV x 10-14 days
Alternative: Doxycycline 100mg PO bid x 14 days |
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Term
| How do you treat genital herpes? |
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Definition
| oral acyclovir, famciclovir, or valacyclovir |
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