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Management of Common Infections

Management of Common Infections. Will Roland, MD. 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

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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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