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Urinary Tract Infections: Outpatient - #PHARMFAX

Bacteria in the urine without symptoms is not a urinary tract infection.

 

Bacteria in the urine without symptoms is not a urinary tract infection. UTI confined to the bladder without systemic signs of infection are uncomplicated, while progression into the kidneys and strucural abnormalities are considered complicated.

Common symptoms of cystitis are pain with urination and frequency. Flank pain, fevers, and other signs of systemic infection sound complicated. We've got good drugs for the bad bugs. E. coli is the most common causative organism, which is the target of our empiric therapy. Outpatient UTI antibiotics can be generalized under four terms; Macrobid, cephalosporins, Bactrim, fluoroquinolones. Macrobid is limited to cystitis since its highly concentrated in the bladder, while the other three can treated cUTI and UTI. My order of preference is cephalosporins, Bactrim, and then fluoroquinolones, but base your options on your local antibiogram. Cephalosporins, specifically 1st and 2nd gen such as cephalexin and cefuroxime, are effective empirically for E. coli with less ADR compared to Bactrim and fluoroquinolones.

Enteric organisms can develop resistance called ESBL, making beta-lactams ineffective. That means your left with nitrofurantoin, Bactrim, and fluoroquinolones. With Pseudomonas sp, our only oral options are fluoroquinolones. Thats probably the EMP calling to follow up on your cultures. Hungry for the PHARMFAX? Check out another video on my page, share the #PHARMFAX with a friend, and I hope you learned something new.

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