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Management of Common Infections

Learn about diagnosing and treating urinary tract infections (UTIs) in women, including differential diagnosis, therapy, and antibiotic options. Understand risk factors, symptoms, and when to consider UTI in the differential diagnosis.

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Management of Common Infections

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  1. Management of Common Infections Will Roland, MD

  2. Urinary Tract Infections • 8 million physician visits/year – cystitis • 100,000 admits/yr – pyelonephritis • Bacteruria is not a disease • Tests for bacteruria or pyuria do NOT establish the diagnosis of UTI • Bacteruria alone is rarely an indication for abx treatment • Routine culture is not required to manage cystitis in women

  3. Acute Uncomplicated Cystitis in Young Women • E. coli – 80% • Risk factors – intercourse, diaphragm and spermicide use, delayed postcoital micturition, previous UTI • Abrupt onset, dysuria, frequency, urgency, suprapubic pain or LBP • Must differentiate it from other causes of dysuria

  4. Differential Diagnosis • URETHRITIS • C. trachomatis, N. gonorrheae, HSV • Gradual onset, mild symptoms, vaginal d/c or bleeding, lower abd pain, new sexual partner, cervicitis or HSV lesions • VAGINITIS • Candida, T. vaginalis • Vaginal d/c or odor, pruritis, dyspareunia, vulvovaginitis

  5. Diagnosis • Dysuria and frequency – 90% UTI • Urine culture • Pyuria • Leukocyte esterase dipstick • Organism and susceptibilities are usually predictable

  6. Therapy • 3 day regimens appear optimal • Trimethoprim-sulfamethoxazole (Bactrim, Septra) • PABA -- Dihydrofolic acid – -Tetrahydrofolate – Purines • TMP/SMX 1 double strength tab (160 mg TMP) po BID x 3 days

  7. TMP/SMX • Cost – Generic $0.15; Brand $0.90 • Side effects • Rash – urticaria, maculopapular, mobilliform • Triggers asthma in sulfite-sensitive pts • HIV – CNS, renal effects • Avoid in megaloblastic anemia

  8. Fluoroquinolones • Ciprofloxacin 250 mg po BID x 3 days • Cost - $5.00/tab • Side f/x – CNS (0.4%): HA, rstlessness, insomnia, nightmares, psychosis • Crystalluria with high doses in alkaline urine • Not recommended for children, pregnancy

  9. Ceftriaxone • 3rd generation cephalosporin – 2 gms/day • Interferes with cell wall synthesis • 1 gm - $20.00 • Gall bladder sludge

  10. UTI’s In Men • Rare, r/o prostatis • Risk factors: homosexual, uncircumcised, colonized sex partner • Usually E. coli • 14 days fluoroquinolone • Obtain urine culture • No need to w/u if responds to therapy

  11. Community-Acquired Pneumonia • 915,900 episodes of CAP in adults >65 per year in the US • Precise etiology remains uncertain in about 50% • Inhalation, aspiration, hematogenous • Risk factors: Cigarrettes, chronic bronchitis, alcoholism, poor nutrition, change in mental status

  12. Community-Acquired Pneumonia • Pneumovax • Influenza vaccine • Antibiotics • Common etiologies: pneumococcus, H. influenza, Legionella spp., Chlamydia pneumonia, Aerobic GNRs, Mycoplasma

  13. Empiric Abx • Previously healthy and no use of abx in last 3 months – macrolide, doxycycline • Presence of comorbidities or use of antimicrobials within the previous 3 months - respiratory fluoroquinolone, beta-lactam plus a macrolide

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