UTI

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Acute Uncomplicated Cystitis Microorganisms
- • Escherichia coli-80-90% of cases
- • Proteus mirabilis
- • Klebsiella pneumoniae
- • Staphylococcus sapropyticus
- • Enterococcus faecalis
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
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
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
Phenazopyridine
- • Pyridium/Azo-Standard/Uristat
- • Urinary analgesic
- • 200 mg TID limit 1-2 days
- • May mask non-responders to therapy
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
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)
Complicated UTI Microorganisms
- • Escherichia coli (50% of cases)
- • Klebsiella pneumoniae
- • Proteus mirabilis
- • Pseudomonas aeruginosa
- • Enterococcus faecalis
- • Serratia marcescens
- • Candida species
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
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

316181

Card Set

UTI

Description

ID 1 (Final): UTI

Updated

2016-02-21T15:05:52Z