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Management

Management. Urinary Tract Infection. Management: Urinary Tract Infection. Pharmacologic Cystitis Pyelonephritis Non-Pharmacologic. Mangement. Cystitis Trimethoprim-sulfamethoxazole Amoxicillin Nitrofurantoin 1 st generation cephalosporins Ciprofloxacin. Mangement.

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Management

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  1. Management Urinary Tract Infection

  2. Management: Urinary Tract Infection • Pharmacologic • Cystitis • Pyelonephritis • Non-Pharmacologic

  3. Mangement • Cystitis • Trimethoprim-sulfamethoxazole • Amoxicillin • Nitrofurantoin • 1st generation cephalosporins • Ciprofloxacin

  4. Mangement • Trimethoprim-sulfamethoxazole • Folic acid synthesis inhibitor • given if culture & sensitivities are not yet available • effective against most strains of E.coli • Tablet • Adult & childn >12 yr Two 400/80 tab or one 800/160 tab • Infants ≥2 mthSulfamethoxazole: 20-30 mg/kg, trimethoprim: 4-6 mg/kg every 12 hr. To be taken for 10-14 days. • Suspension: 24 mg/kg • 6-12 yr 480 mg (5 mL) • 6 mth-5 yr 240 mg (2.5 mL) • 6 wk-5 mth 120 mg (1.25 mL). • AE: Stevens-Johnson Syndrome, hepatitis, cholestatic jaundice • CI: megaloblastic anemia

  5. Management • Amoxicillin • Interferes with bacterial cell wall synthesis • also effective as TMP-SMX • Dosing (suspension) • Adult & childn > 40 kg 250 mg/5 mL every 8 hr • childn 2-10 yr & patient <40 kg 125 mg/5 mL every 8 hr • infant 6-12 mth 1-2 mL 100 mg/mL every 8 hr • <6 mth 0.5-1 mL 100 mg/mL every 8 hr. • AE: Diarrhea, indigestion, occassional rash either urticarial or erythematous

  6. Management • Nitrofurantoin • interferes with cell metabolism and cell wall synthesis • has the advantage of being active against Klebsiella-Enterobacter organisms • Dosing • >3 mth and older children: 3 mg/kg daily in 4 divided doses • AE: Peripheral polyneuropathy, hepatotoxicity, Stevens-Johnson syndrome

  7. Management • Cephalosporins • Inhibits cell wall synthesis • Dosing • 3 mo-12 yo: 30 mg/kg/day susp PO div q12h x10 days; Max: 1000 mg/day • >13 yo: 250-500 mg tab PO bid x5-10 days • AE: Anaphylaxis, nephrotoxicity, pseudomembranous colitis

  8. Management • Ciprofloxacin • Inhibits DNA Gyrase and topoisomerase IV preventing replication and repair • Alternative agent for resistant microorganisms like Pseudomonas • Dosing • 1-17 yo: 6-10 mg/kg IV q8h Max: 400 mg/dose IV; 750 mg/dose PO • AE: peripheral neuropathy , tendon damage, torsades de pointes, Stevens-Johnson syndrome

  9. Mangement • Cystitis • Ampicillin • Gentamicin • 1stgeneration cephalosporins • Ciprofloxacin

  10. Management • Ampicillin • Inhibits cell wall synthesis • given if culture & sensitivities are not yet available • Combined with gentamicin • Dosing • 50-100 mg/kg daily, given in equally divided doses every 6 hr. Max: 2-4 g/day • AE: Anaphylactic shock; pseudomembranous colitis; neuromuscular hypersensitivity; electrolyte imbalance

  11. Management • Gentamicin • Inhibits bacterial protein synthesis • Combined with ampicillin • Dosing • Childn: 2-2.5 mg/kg • infant & neonate: 2.5 mg/kg. To be given 8 hrly. • AE: vertigo, muscle cramps, ototoxicity

  12. Management • Non-Pharmacologic • increasing fluid intake to enhance urine dilution and output • Avoid infrequent voiding • Proper hygiene • Avoid using antibiotics when not needed

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