N323 - Week 8 (Drugs for UTI)

Drugs for UTI

1. fosfomycin (Monurol)

2. nitrofurantoin (Macrobid, Macrodantin)

3. trimethoprim-sulfamethoxazole TMP-SMX (Bactrim, Septra)

4. phenazopyridine (Pyridium; AZO-OTC)

Fosfomycin (Monurol)

MOA:

Classification:

Primary use:

Adverse effects:

Nursing Considerations: (3)

MOA: inhibits bacterial wall synthesis by inactivating the enzyme, pyruvyl transferase; bactericidal

Classification: Antibiotic

Primary use: uncomplicated UTIs

Adverse effects: safe

Nursing Considerations:

-often given as a single, one time dose

-monitor for diarrhea

-encourage PO hydration

nitrofurantoin (Macrobid, Macrodantin)

MOA:

Classification:

Primary use:

Adverse effects:

Nursing Considerations: (4)

MOA: alters bacterial ribosomal proteins leading to inhibition of protein synthesis, aerobic energy metabolism, DNA, RNA, & cell wall synthesis (1st line of treatment for UTI)

Classification: Antibiotic (bacteriostatic but can become bactericidal at high doses)

Primary use: Uncomplicated UTIs

Adverse effects: hepatotoxicity (rare)

Nursing Considerations:

-monitor LFTs

-contraindicated at term of pregnancy

-use w/ caution for impaired renal fxn

-must keep hydrated on this med

trimethoprim-sulfamethoxazole TMP-SMX (Bactrim, Septra)

MOA:

Classification:

Primary use:

Adverse effects:

Nursing Considerations:

MOA: suppress bacterial growth by inhibiting bacterial synthesis

Classification: Antibacterial-bacteriostatic

Adverse effects: agranulocytosis (low WBC), hemolytic anemia (low RBC), Steven-Johnson syndrome (serious)

Nursing Considerations:

-caution in pts w/ CKD

-not for use in sulfa allergy

-monitor for signs of agranulocytosis & thrombocytopenia

-teach pt to avoid direct sunlight during therapy

-used often for strong bladder penetration for UTIs

Phenazopyridine (Pyridium; AZO-OTC)

MOA:

Classification:

Primary use:

Adverse effects:

Nursing Considerations: (3)

MOA: azo dye which exerts local anesthetic or analgesic on urinary tract mucosa

Classification: urinary analgesic

Primary use: UTI spasm relief (used for pain, not for treatment)

Adverse effects: generally very mild

Nursing Considerations:

-will turn urine red-orange-brown

-does not have anti-bacterial properties, used in conjunction w/ antibiotics

-generally used for 3 days only

Nursing Considerations for UTI Drugs (4)

obtain cultures from appropriate sites BEFORE antibiotic therapy

-before therapy, assess allergies, possible drug interactions; renal, liver, & cardiac fxn and other labs

-Pts should complete med treatment

-may decrease efficacy of oral contraceptives