Some antibiotics used for cystitis for not reach adequate levels in kidney and

Some antibiotics used for cystitis for not reach

This preview shows page 27 - 30 out of 31 pages.

Some antibiotics used for cystitis for not reach adequate levels in kidney and are not effective for pyelonephritis N/V, back/flank or abdominal pain can often accompany upper UTI symptoms so must consider IV or PO Question 2: complicated or uncomplicated Complicated UTIs considered to potentially be more difficult to treat, relapse more frequently, or more likely to need surgical intervention Generally longer courses or different drugs are recommended uncomplicated: upper or lower UTI in otherwise healthy, non-pregnant adult women Complicated: lower or upper UTI in presence of a structural or functional abnormality or urinary catheter Structural: kidney stones, enlarged prostate, obstruction, urethral stent or catheter Functional: incontinence, post-void residuals, neurogenic bladder Metabolic/hormonal: diabetes, pregnancy Immune defect: organ transplant, HIV, neutropenia Infections due to multi-drug resistant pathogens Term complicated does not indicate site or severity of infection Severity describes the level of systemic involvement that occurs as a result of
Image of page 27

Subscribe to view the full document.

infection More severe: hypotension, tachycardia, sepsis Question 3: severity Mild to moderate pts without risk factors for MDRP can likely receive oral therapy and be treated as outpatients Moderate to severe pts may need IV therapy initially that is broader in spectrum May not be able to take PO meds May have greater risk from initially ineffective antibiotic therapy Potential risk of infection due to more resistant pathogen Types of antibiotic therapy Empiric Pathogen-directed Acute Cystitis (lower UTI) Symptoms primarily localized to bladder Can be uncomplicated or complicated Predominantly caused by E. Coli Wider spectrum of pathogens possible who are complicated or have recent healthcare exposure Uncomplicated Cysitis - empiric Treatment 1st line Nitrofuranotin 100 mg BID x 5D (if CrCl > 60) Caution in G6PD deficiency SE: pneumonitis, fibrosis, peripheral neuropathy, hepatic dysfunction, optic neuritis Bactrim 1 DS tab PO BID x 3D Avoid if resistance > 20% Risk of crystalluria and AKI SE: AKI, hyperkalemia, bone marrow suppression, drug interaction with warfarin fosfomycin 3g PO x 1D 2nd line FQ: levo or cipro 3 day therapy SE: QT prolongation, tendon rupture, may decrease seizure threshold and affect blood glucose levels ß-lactams: augmentin, cefdinir, cefpodoxime x 5-7D Less evidence for cephalexin and cefuroxime Amoxicillin and ampicillin should not be used alone for empirical therapy due to resistance Acute Pyelonephtitis Clinical presentation High grade fever Flank pain N/V, and/or dehydration Altered mental status, lethargy, malaise Severity
Image of page 28
Mild to moderate: oral antibiotics x 5-10D Severe symptoms More aggressive treatment Hospitalization and IV antibiotics initially Antibiotic duration 10-14 days
Image of page 29

Subscribe to view the full document.

Image of page 30
  • Fall '19
  • Tetracycline, UTI, Ceftriaxone

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern

Ask Expert Tutors You can ask 0 bonus questions You can ask 0 questions (0 expire soon) You can ask 0 questions (will expire )
Answers in as fast as 15 minutes