UTI’s, Diverticulitis, PID

URINARY TRACT INFECTIONS

Microbiology  —  Enterobacteriaceae (aka enterics, coliforms): 
  • Gram Negative Rods (GNR)
Uncomplicated UTIs
  • Escherichia coli  [most common]
  • Proteus mirabilis
  • Klebsiella pneumoniae
Only in Complicated UTI
  • Serratia marcescens
  • Acinetobacter species
  • Enterobacter species
  • Pseudomonas aeruginosa
Complicated =  compromised host, indwelling cath., neurogenic bladder, etc. 
•   E. coli still most common
Staph saprophyticus: also a pathogen (other Staph = skin contaminants)
 

Antibiotics  —  cover Gram-Negative Rods (also S. saprophyticus)

Out-Patient

  • Amoxicillin [lots of resistance]
  • Amoxacillin + clavulanate
  • Cephalosporins  [all generations]
  • TMP-SMX  [lots of resistance]
  • Doxycycline [tetracyclines]
  • Fluoroquinolones
  • Nitrofurantoin  (NOT if Pyelo)
  • Fosfomycin  (NOT if Pyelo)  [$$$]

In-Patient

  • Gentamicin / other Aminoglycosides
  • Cephalosporins (parenteral)
  • Carbapenems IV [severe infections]
  • Pipericillin, Carbenicillin [Pseudomonas]
  • Chloramphenicol [no longer used]
HOW TO PICK:
  • Know resistance patterns in your area
  • For Cystitis: Nitrofurantoin / Fosfomycin
    • Save others for Pyelo
  • Pyelonephritis:  Amoxicillin + clavulanate OR Cephalexin
    • Save Quinolones for sicker patient
    • Use Amoxicillin / TMP-SMX if “Sens” on C&S
DON’T  USE  (don’t cover GNR’s)
               •  Penicillin                              •  Macrolides
               •  Clindamycin                        •  Metronidazole
 

DIVERTICULITIS  (out-pt Tx)

Pathogens:  Gram-Negative Rods PLUS Anaerobes (esp. Bacteroides)

Possible Regimens:
  • Amoxicillin-clavulanate [not if Pseudomonas]
  • Ciprofloxacin + Metronidazole
  • Ciprofloxacin + Clindamycin
  • Monifloxacin

PELVIC INFLAMMATORY DISEASE

Pathogens:
               •  STD’s (gonorrhea, chlamydia)        •  Anaerobes
               •  Gram-Neg Rods                                      •  Garnerella, H. Flu, Group B Strep
 
Possible Out-Pt Regimens
 
1-Dose:  Ceftriaxone 250 mg IM  +  Azithromycin 2 gm p.o. [GC & CT]
OR  Cefoxitin 2 g IM   +  Probenecid 1 g p.o.  [GC]
PLUS
2 wks Tx:  Doxycycline 100 mg B.I.D. / Ofloxacin 300 BID   [GNRs, CT]
•   If PID after recent pelvic instrumentation:
•   Ofloxacin instead of Doxy (better GNR coverage)
•   add Metronidazole 500 mg B.I.D. x14d (anaerobes)

.

Advertisements