UTI

Complicated

Uncomplicated

Risk factors

Treatment

Examples

sexual intercourse

new sexual partner

history of a UTI in a first-degree female relative

Cystitis

Presentation

frequency

Urgency

Urinalysis and culture are not typically needed

dysuria

Pyelonephritis

Treatment

Presentation

Diagnosis

fever

chills

flank pain

requires testing

Use results from urinalysis and urine culture to confirm diagnosis and guide therapy

Treatment

inpatient: non-pregnant women with acute pyelonephritis

outpatient: non-pregnant women with acute pyelonephritis

fluoroquinolones

ciprofloxacin 500 mg PO BID x7d

ciprofloxacin ER 1000 mg PO qd x7d

levofloxacin 750 mg PO qd x5d

folate inhibitors

TMP/SMX 160mg/800mg PO BID x14d

initial

step-down: same as outpatient

ciprofloxacin 400 mg IV BID

levofloxacin 250-500 mg IV qd

ceftriaxone 1000 mg IV qd

aminoglycoside 5 mg/kg IV qd

imipenem/cilastatin 500 mg IV q6h

Infections occurring despite the presence of anatomical protective measures

UTI in males are by definition complicated

Infections occurring due to anatomical abnormalities, for example, an obstruction, hydronephrosis, renal tract calculi, or colovesical fistula

Infections occurring due to an immune compromised state

Atypical organisms causing UTI

Recurrent infections despite adequate treatment

Infections occurring in pregnancy

Infections in renal transplant patients

hospitalized with critical illness warranting intensive care or urinary tract obstruction

vancomycin + antipseudomonal carbapenem

other hospitalized patients

risk for MDR

yes: pip-tazo or antipseudomonal carbapenem

no: ceftriaxone or pip-tazo or fluoroquinolones

outpatient

risk for MDR

no, and no concerns with fluoroquinolone: ciprofloxacin or levofloxacin

yes: ertapenem FOLLOW BY ciprofloxacin or levofloxacin

no, but with concerns with fluoroquinolone: ceftriaxone or ertapenem or gentamin or tobramycin FOLLOWED BY TMP-SMX or amoxcillin/clavulanate or cefpodoxime or cefdinir or cefadroxil

First line agents

Macrobid

Trimethoprim/sulamethoxazole

MOA: inactivates or alters bacterial ribosomal proteins leading to inhibition of protein synthesis, aerobic energy metabolism, DNA, RNA, and cell wall synthesis

PK/PD:60-90% protein binding, half-life 20-60min (prolonged with renal impairment), renal excretion

Avoid in CrCl <30 mL/min and patients on dialysis

Indications: acute uncomplicated cystitis, prophylaxis for recurrent infection in cystitis

Special populations: avoid in elderly and children <1 month of age; can cross placenta and is present in breast milk

Indicated if it has not been used for urinary tract infection in prior 3 months and local resistance for Escherichia coli known to be < 20%

Dosing: then use 160 mg/800 mg orally twice daily for 3 days

Monitoring: S/Sx of pulmonary reaction, numbness or tingling in extremities, CBC, periodic LFTs, renal function

Warnings: Risk of pulmonary toxicity, peripheral neuropathy and hepatic reactions.

Dosing: 100 mg BID for 5-7 days

Drug Interactions:

Special Populations:

Warnings: hypersensitivity to sulfa drugs, severe rash (SJS).

PK/PD:

Drug Interactions:

Monitoring:

Adverse Reactions:

Adverse Reactions: Rash, GI discomfort, hyperkalemia, hyponatremia, myalgia

Headache (6%) Nausea (8%) Hyperphosphatemia (5%) Anemia (5%)

dapsone, eplerenone, nitric oxide, prilocaine

CBC, electrolytes, renal function

ACEis, ARBs, digoxin, dofetilide, eplerenone. dapsone, cyclosporine, antidiabeic agents, nitric oxide, phenytoin, prilocaine, rifampin

CL of TMX is 19% lower in elderly patients. Use with caution in pts with decreased CrCl. Can cross placenta and is present in breast milk

A: rapid oral absorption - 90-100% D: Vd ~1.3L/kg M: hepatic via CYP2C9
E: excreted as metabolites and unchanged drug