Antibiotic - UTI

who is most susceptible to UTI

women between 15 and 34 yrs old

who is at most risk of UTI

previous infection, age, sexual activity, patients on oral contraceptive

how can we classify recurrent UTI

if patient has had 3 or more in 12 months or 2 or more in 6 months

referral points

o Children < 16 years old

o Patients with diabetes

o Duration more than 7 days (complicated)

o Vaginal discharge (may indicate vaginitis)

o Women > 70 years old

o Pregnancy

o Haematuria

o Immunocompromised

o Patients with associated fever and flank pain.

o Male patient.

trimethoprim

- regular dose

- prophylaxis treatment dose

- take 2 tablets as first dose then one tablet twice a day for 7-10 days (200mg bd)

- 100mg at night, can be upped to 100mg bd

trimethoprim

- monitoring

- contraindications

- monitor blood count and renal function in long term use

- care in patients using anticonvulsants, can reduce effect of hormonal contraception

trimethoprim

- side effects

Diarrhoea

electrolyte imbalance

nitrofurantoin

- dose

50mg qds/ 100mg bd for 3 days (7 days if male or pregnant)

take with food or milk

nitrofurantoin

- care and caution

- warning signs

- care in patients with renal dysfunction, caution with patients with diabetes and electrolyte imbalance

- stop treatment if patient has pulmonary or neural symptoms

sulphonamides

- what are they

- what do they do

- spectrum of activity

structural analogues for PABA

inhibit folic acid synthesis

broad spectrum

what is silver sulphadiazine used for

topical antibiotic used for burn wounds, leg ulcers and pressure sores

what is sulfadiazine used for

prevention of rheumatic fever

what is dapsone used for

leprosy, dermatitis

also has immunomodulatory effects

side effects of sulphonamides

crystalluria, type of brain damage, stevens-johnson syndrome

name 4 beta lactam antibiotics

Penicillins

Cephalosporins

Carbapenems

Monobactams

penicillin

- beta lactamase sensitive

- penicillinase resistant

- broad spectrum

- mecillinam type

- benzylpenicillin, phenoxymethylpenicillin.

- flucloxacillin

- amoxicillin, ampicillin

- pivmecillinam

what is penicillin used for

Throat, ear, pneumonia, cellulitis, endocarditis, meningitis, diphtheria, sinusitis

penicillin

- side effects

- cautions and warnings

- GI disturbances

- Allergy, monitor in patients taking methotrexate and warfarin

flucloxacillin

- how to take

1 hr before or 2hrs after food

with water

do not lie down

what do cephalosporins treat

pneumonia, meningitis, billary - tract infections, peritonitis, UTI, dental, otitis media, skin, bone and joint

cephalosporins

- 1st gen

- 2nd gen

- 3rd gen

- advanced gen

-> what do each of the target - gram pos (+) or gram neg (-) bacteria

- cefalexin (+)

- cefaclor, cefuroxime (+/-)

- cefixime, cefotaxime, ceftazidime, ceftriaxone (-)

- ceftaroline, ceftobiprole, cefidercocl

side effects of cephalosporins

GI disturbances

skin reactions

cephalosporin

- caution

patients with penicillin allergy - esp 1st and 2nd gen

carbapenems

- name

- what do they treat

- Ertapenem, imipenem + cilastatin / relebactam, meropenem /+ vaborbactam.

- Broad spectrum against gram positive and negative (inc b-lactamase producing).

carbapenems

- indications

Septicaemia, H pneumonia, intra-abdominal, skin and sot tissue.

carbapenems

- contraindications

sodium valproate

monobactam

- what does it treat

- name

- ROA

- Gram negative bacteria only

- Aztreonam

- Given parenterally or via inhalation.

monobactam

- caution

- side effects

- Used with caution in patients with renal or hepatic impairment

- Nausea, diarrhoea, cramps, mouth ulcers, hepatitis.

glycopeptide

- MOA

- name 2

- side effects

- Inhibit cell wall synthesis of gram positive only

- Vancomycin and teicoplanin

- Can cause nephrotoxicity and ototoxicity (permanent or transient).

glycopeptide

- indications

- Skin and soft tissue, bond and joint, pneumonia, endocarditis

- orally to treat c.difficile

phosphonic acid derivative

- MOA

- spectrum activity

- Fosfomycin blocks early cell wall synthesis

- Broad spectrum against gram negative and gram positive.

phosphonic acid derivative

- indications

- how to take

- side effects

- UTI as second line

- 3g at night on empty stomach and bladder

- dissolve in glass of water and drink straight away

rifamycins

- MOA

- side effects

- contraindications

- target RNA polymerase

- Influenza like syndrome, shortness of breath, GI, psychosis.

- Decrease the activity of oral hormonal contraceptives and warfarin.

what are the indications of:

- rifampicin

- rifabutin

- rifaximin

- treat tuberculosis and other mycobacterial infections

- second line treatment of mycobacterium tuberculosis

- travellers diarrhoea and hepatic encephalopathy.

quinolones

- MOA

- 2nd gen

- 4th gen

- indications

- Affect topoisomerase causing irreversible chromosome damage

- Ciprofloxacin, Ofloxacin, levofloxacin

- delafloxacin, moxifloxacin (also targe anaerobes)

- RTI, Genito-urinary, GIT, skin and soft tissue, otitis externa.

quinolones

- adverse effects

- caution

- interactions

- Induce convulsions (with NSAIDS), tendon damage, QT prolongation, arthropathy kids

- Separate (2hr before / 4hr after) from antacids, iron, calcium, magnesium, diary

- Interact with warfarin, methotrexate, olanzapine, duloxetine.

tetracyclines

- name

- indications

- Doxycycline, lymecycline, minocycline, tigecycline.

- RTI, UTI, STU, rickettsial, ophthalmic

- Lymecycline: acne and should be used for at least 8 weeks but caution after 6 months

tetracyclines

- side effects

- contraindications

- photosensitivity, oesophageal irritation, hyperpigmentation

- do not ingest with antacids, iron, zinc, calcium or systemic retinoids

aminoglycosides

- name

- indications

- side effects

- Amikacin, gentamicin, neomycin, tobramycin

- Pneumonia, complicated UTI, intra-abdominal, skin infection

- Neurotoxicity, ototoxicity, nephrotoxicity

macrolides

- name

- indications

- side effects

- interactions

- Erythromycin, clarithromycin, azithromycin

- Skin infection, RTI, otitis media, acne, sinusitis, bronchitis, Clarithromycin can be used in the treatment of h. pylori

- GI disturbances, QT prolongation

- Interact with statins, warfarin, DOACs, other QT drugs.

Lincosamides (Clindamycin)

- indications

- side effects

-Bone and joint, skin and soft tissue, acne, bacterial vaginosis

- GI

Oxazolidinone

- name

- indication

- side effect

- Linezolid, tedizolid

- Pneumonia, complicated skin and soft tissue

- Candidiasis, myelosuppression, serotonin syndrome.