Urinary Tract Infection - UTI

What is the OTC dose of phenazopyridine during UTI?

100 mg TID x 2 days

What is the prescription dose of phenazopyridine during UTI?

200 mg po TID x 2 days.

What is the drug of choice for complicated UTIs?

AMP + Gentamycin or Zosyn (Pipperacillin + Tazobactam) or Timentin (Ticarcillin + Clavulanic Acid) or Doripenem or Imipenem or Meropenem x 2-3 weeks.

What agents are safe to treat UTI in pregnant women?

Amoxicilin (near term is safe), nitrofurantoin, oral cephalosporine and fosfomycin.

Is there any contraindication with phenazopyridine?

Avoid use in renal impairment (CrCl < 50 ml/min).

What is the brand name of phenazopyridine?

Azo, Uristat, Pyridium.

What is the drug of choice for acute uncomplicated cystitis if ≥ 20% of local E. coli is resistant to SMX/TMP or if patients is allergic to sulfa?

Ciprofloxacin 250 mg BID x 3 days OR Ciprofloxacin ER 500 mg QD x 3 days OR Levofloxacin 250 mg QD x 3 days or Nitrofurantoin 100 mg BID x 5 days OR Fosfomycin single dose 3 g in 4 oz of water.

What is the recommended procedure when UTI treatment doesn't show response on the 3-day course?

Culture followed by treatment for 2 weeks.

How is the lower urinary tract infection called?

Cystitis.

Why fluoroquinolones should be avoided in pregnant women with UTI?

Due to cartilage toxicity and arthopathies.

Why tetracyclines should be avoided in pregnant women with UTI?

Due to teratogenic effects.

What are the signs & symptoms of cystitis?

Dysuria (painful urination), urgency, frequency, burning, nocturia, suprapubic heaviness, hematuria (blood in the urine).

What are the most common pathogens in acute uncomplicated pyelonephritis?

E. coli, Enterococci, P. mirabilis, K. pneumoniae, P. aeruginosa.

What are the most common pathogens in acute uncomplicated cystitis?

E. coli, S. saprophyticus and Enterococcus.

What are the signs & symptoms of pyelonephritis?

Flank pain, abdominal pain, fever, nausea and vomiting, malaise.

What is the drug of choice to treat moderate ill outpatient suffering from acute uncomplicated pyelonephritis?

Fluoroquinolones PO x 5 - 7 days (Cipro 500mg BID or Cipro 1000mg ER QD or Levofloxacin 750mg QD or Ofloxacin 400mg BID.

What is the drug of choice to treat severe hospitalized patients suffering from acute uncomplicated pyelonephritis?

Fluoroquinolones, Ampicillin + Gentamycin, Zosyn (Pipperacillin + Tazobactam), Ceftriaxone (Rocephin) x 14 days. IV route is preferred. Most acute uncomplicated pyelonephritis require hospitalization.

What is the prophylaxis guidelines for acute uncomplicated cystitis?

If there are three or more episodes in one year, take 1 SMX/TMP SS (400mg/80mg) QD or SMX/TMP DS (800mg/160mg) post coitus.

What is a complicated UTI?

It is generally a result from an abstruction or abnormalities (congenital, stones, indwelling catheter) or neurologic deficit that interferes with the normal flow of urine.

What is an uncomplicated UTI?

It is not associated with structural or neurological abnormalities that may interfere with the normal flow of urine.

What risks does SMX/TMP have during pregnancy?

It is pregnancy category C (no controlled studies in humans have been performed and animal studies have shown adverse events, OR studies in humans and animals are not available, give only if potential benefit outweighs the risk), but 2 weeks before EDC it is pregnancy category D (positive evidence of fetal risk is available, but the benefits may outweigh the risk if life threatening or serious disease) as it can cause hyperbilirubinemia and kernicterus in the 3rd trimester.

What can be done to relieve burning symptoms in UTIs?

May add the urinary analgesic phenazopyridine for 2 days (only not to mask the antibiotic effects).

What are the sides effects of phenazopyridine?

May cause hemolytic anemia in patient s with G6PD deficiency. It may also cause red-orange coloring of the urine and other body fluids (contact lens and clothes can be stained).

What quinolones cannot be used to treat UTIs? Why?

Moxifloxacin and Gemifloxacin do not reach high levels in the urine.

How is the upper urinary tract infection called?

Pyelonephritis.

What is the drug of choice for acute uncomplicated cystitis?

SMX/TMP DS (800mg/160mg) tab BID x 3 days.

For how long pregnant women must be treated for UTI? Why?

Seven days. If not, can lead to premature birth or pyelonephritis.

What is the recommendation when dispensing phenazopyridine?

Take with food or following food to minimize stomach upset.

Is acute uncomplicated cystitis treated differently in females?

Yes, generally it is a 3-day therapy. Longer term therapy needed for UTI's in men, pregnancy, elderly people with diabetes and children.