Highest incidence is among
sexually active women 18-24 years old
The prevalence in men increases with ___ as structural abnormalities occur
age
Predisposing Risk Factors for UTI: Premenopausal women
Diabetes, diaphragm use, past history of UTI during childhood, sexual intercourse
Predisposing Risk Factors for UTI: Postmenopausal women
Estrogen deficiency, history of UTI before menopause, urinary catheterization or incontinence
Pyelonephritis symptoms
Costovertebral angle tenderness, N/V
Acute Uncomplicated Cystitis: Trimethoprim/sulfa: __ day treatment
3 day treatment
Acute Uncomplicated Cystitis: Trimethoprim/sulfa: Pregnancy: 3rd trimester
Pregnancy: Avoid in the 3rd trimester
Acute Uncomplicated Cystitis: Trimethoprim/sulfa: 1st trimester
Pregnancy: administer with folic acid to decrease risk of kernicterus
Acute Uncomplicated Cystitis: Trimethoprim/sulfa: May cause h_____
hyperkalemia
Acute Uncomplicated Cystitis: Nitrofurantoin: _ day treatment
5 day treatment
Acute Uncomplicated Cystitis: Nitrofurantoin: For ___ only
cystitis
Acute Uncomplicated Cystitis: Nitrofurantoin: do not use if ___ < 30mL/min
CrCl
Acute Uncomplicated Cystitis: Nitrofurantoin: do not use if patient is over
65
Acute Uncomplicated Cystitis: Nitrofurantoin: adverse effects- p___ n___, r___ f___
peripheral neuropathy, renal failure
Acute Uncomplicated Cystitis: Pregnancy: > 37 weeks gestation increases risk of
hemolytic anemia in infant
Acute Uncomplicated Cystitis: Fosfomycin
Single dose
Acute Uncomplicated Cystitis: Alternative Treatments
Beta-lactams- amoxicillin/clavulanate, cefdinir, cefaclor, cefpodoxime
Acute Uncomplicated Cystitis: FQs
last resort only. And don’t use moxifloxacin
Treatment: Acute Uncomplicated Pyelonephritis: If local resistance is <10% use ___ or ____
ciprofloxacin
levofloxacin
Treatment: Acute Uncomplicated Pyelonephritis: If local resistance is > 10% use ___ or ____
ceftriaxone or gentamicin
Treatment: Acute Uncomplicated Pyelonephritis: 2 things that should Not be used
TMP and beta lactams
Treatment: Acute Uncomplicated Pyelonephritis: Inpatients: Initial treatment should be _____
parenteral
Treatment: Acute Uncomplicated Pyelonephritis: Inpatients: Use f__, g___, c___
FQ
Gentamicin +/- ampicillin or penicillin
Extended spectrum cephalosporin
Treatment: Acute Uncomplicated Pyelonephritis: Inpatients: If fevers or blood cultures persist over first 3-4 days, consider
urinary obstruction or abscess
Pregnant women should be tested for
ASB at 12-16 weeks of gestation
Asymptomatic Bacteriuria (ASB) and UTIs in Pregnancy: If untreated, can result in
low birth weight or premature delivery
ceftriaxone may cause ___ if administered the day before birth
kernicterus
can be used during 2nd trimester
avoid > 37 week gestation due to risk of hemolytic anemia in infants
Nitrofurantoin
Treatment in Pregnancy: Fluoroquinolones: avoid due to toxic effect on
developing cartilage; abortifacient
Treatment in Pregnancy: TMP/SMX: avoid during 1st week due to risk of
folate sensitive birth defects (administer with folic acid)
Treatment in Pregnancy: TMP/SMX: avoid during __ due to risk of kernicterus
3rd trimester
Treatment in Pregnancy: a safe drug is
Fosfomycin
Treatment in Pregnancy: Prophylaxis for recurrent infections: ___ or ___
nitrofurantoin or TMP/SMX
Recurrent: infection that occurs more than ___ days after initial infection with a different organism
14
Relapse: infection that occurs ___ of original infection with the same organism
within 14 days
TMP/SMX: Counselling Points:
use sunscreen, drink water, watch for hyperkalemia
TMP/SMX: may increase the effect of
warfarin
Nitrofurantoin: Counselling Points:
urine/stool looks different
caution if patient has G6PD-deficiency; can cause hemolytic anemia
Nitrofurantoin: monitor ___ and ___
hepatic and renal
Ciprofloxacin: avoid in CrCl<30mL/min due to increased risk of ___ and ___
tendon rupture and CNS effects
Ciprofloxacin: causes p___ and p____
phototoxicity/ photosensitivity
Ciprofloxacin: avoid ___ and ___ foods
dairy and calcium fortified
Ciprofloxacin: risk of increased ____, esp in renal and elderly
QT prolongation
Ciprofloxacin: increases the effect of
warfarin
most common organism to cause UTI
e coli