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Toronto Notes 2019 Infectious and Inflammatory Diseases
Urology U13
Infectious and Inflammatory Diseases
Table 8. Antibiotic Treatment of Urological Infections
Condition
Urethritis
Simple, Uncomplicated UTI
Complicated UTI
Recurrent/Chronic Cystitis
Acute Prostatitis
Chronic Prostatitis
Epididymitis/Orchitis
Acute Uncomplicated Pyelonephritis
Drug
Non-Gonococcal
azithromycin (1 g PO)
OR
doxycycline (100 mg PO bid) Gonococcal
ceftriaxone (250 mg IM) AND treat for Chlamydia trachomatis
TMP-SMX (160 mg/800 mg PO bid) OR
nitrofurantoin (100 mg PO bid)
ciprofloxacin (1 g PO daily OR 400 mg IV q12h)
OR
ampicillin (1 g IV q6h) + gentamicin (1 mg/kg IV q8h) (used for relatively short courses because of toxicity)
OR
ceftriaxone (1-2 g IV q24h)
Prophylactic Treatment
Continuous: TMP-SMX (40 mg/200 mg PO qHS OR 3x/wk) OR
nitrofurantoin (50-100 mg PO qHS)
Post-Coital: TMP-SMX (40 mg/200 mg-80 mg/400 mg) OR
nitrofurantoin (50-100 mg PO qd)
ciprofloxacin (500-750 mg PO bid) OR
TMP-SMX (160 mg/800 mg PO bid) OR
IV therapy with gentamicin and ampicillin, penicillin with β-lactamase inhibitor, 3rd gen cephalosporin, OR a fluoroquinolone
ciprofloxacin (500 mg PO bid)
<35 yr
ceftriaxone (200 mg IM) AND
doxycycline (100 mg PO bid)
≥35 yr
ofloxacin (300 mg PO bid)
ciprofloxacin (500 mg PO bid)
± ceftriaxone (1 g IV) OR ciprofloxacin (400 mg IV)
OR
IV therapy with a fluoroquinolone, gentamicin and ampicillin, extended spectrum cephalosporin, extended spectrum penicillin, OR a carbapenem
Duration
x1 d 7d x1
3d 5d
up to 2-3 wk up to 2-3 wk
up to 2-3 wk
6-12 mo
6-12 mo within 2
within 2
2-4 wk 4 wk
4 wk (IV
4-6 wk
x 1 10 d
10 d
7d x1
Antibiotic therapy should always be based on local resistance patterns and adjusted according to culture and sensitivity results
h of h of
and
coitus coitus
oral step-down)
and oral step-
Cystitis: Common Pathogens KEEPS
Klebsiella sp.
E. coli (90%), other Gram-negatives Enterococci
Proteus mirabilis, Pseudomonas
S. saprophyticus
Acute uncomplicated pyelonephritis: suspected or confirmed Enterococcus infection requires treatment with ampicillin
14 d total(IV down
Urinary Tract Infection
• forUTIsduringpregnancy,seeObstetrics,OB29
Definition
• symptomssuggestiveofUTI+evidenceofpyuriaandbacteriuriaonU/AorurineC&S
■ if asymptomatic + 100,000 CFU/mL = asymptomatic bacteriuria; only requires treatment in certain
patients (e.g. pregnancy, immunosuppressed, prior to urologic surgery)
Classification
• uncomplicated:lowerUTIinasettingoffunctionallyandstructurallynormalurinarytract
• complicated:structuraland/orfunctionalabnormality,malepatients,immunocompromised,diabetic,
iatrogenic complication, pregnancy, pyelonephritis, catheter-associated
• recurrent:seeRecurrent/ChronicCystitis,U14
Risk Factors
• stasisandobstruction
■ residual urine due to impaired urine flow e.g. PUVs, reflux, medication, BPH, urethral stricture,
cystocele, neurogenic bladder • foreignbody
■ introduce pathogen or act as nidus of infection e.g. catheter, instrumentation