uja5
-
Upload
encarncaolubby -
Category
Documents
-
view
214 -
download
0
description
Transcript of uja5
www.cdm.gouv.qc.ca
Urinary Tract Infections in Adults
Translated from the original French version published October 2009
This clinical guide is provided for information purposes and is not a substitute for the practitioner’s judgment.
GENERAL
DIAGNOSISUrine analysis test (microscopic or stick): simple, low cost and reliable• Presenceofnitrites,leukocytesandde novourinarytractsymptoms:goodpredictivevalueofUTI• Absenceofnitritesorleukocytes:goodnegativepredictivevalue
Urineculture• NotveryusefulinuncomplicatedUTIs(exceptifreccurence<1month)• RecommendedincomplicatedUTIsorifpersistentsymptoms
TREATMENT GUIDELINES• Asymptomaticbacteriuria:• Treatonlypregnantwomenandpatientsundergoinggenito-urinarysurgery.• Antimicrobialtherapyinpregnantwomenmustbeadaptedtotheircondition.
90%ofurinarytractinfections(UTIs)arecausedbyenterobacteria.• Mostcommonpathogens:Escherichia coli, Staphylococcus saprophyticus, enterococci
UncomplicatedUTIsoccur:• Usuallyinwomenofchildbearingage• Inlowerurinarytract,withoutanatomicabnormality
ComplicatedUTIsoccurin:• Menandchildren• Pregnantwomen• Patientswithurinarycathetersorthosewaitingforurinarycatheterization• Upperurinarytract• Incaseof:
- Anatomicabnormalityoftheurinarytract - Diabetesmellitus- Immunosuppression - Symptomsdevelopingforover7days
Uncomplicated UTIs
3-daytherapy:• Thestandardfortreatinguncomplicatedcystitisinwomen.Mayalsobeusedinwomenover65 withoutanatomicabnormalityoftheurinarytract.
• OnlyTMP-SMXandfluoroquinolonesmaybeprescribedfor3days.
Trimethoprim-sulfamethoxazole(TMP-SMX):• InQuébec,approximately15%ofenterobacteriaareresistanttoTMP-SMX.• TMP-SMXisfirst-linetreatmentEXCEPTwhenlocalresistanceexceeds20%, whentherehasbeenrecentantimicrobialtreatmentwithTMP-SMXorrecenthospitalization.
• Itispreferabletoknowtheprevalenceoflocalresistancebeforeprescribing.• Incaseofsulfonamideallergy,trimethoprimaloneisanalternative.
β-lactamsandnitrofurantoin:• Efficacyprovenin7-daycourses.
* Adjustdosageaccordingtorenalfunction.† Theantibioticsarelistedinalphabeticalorderoftheirgenericnamewithintheirgroup.Onlyonebrandnameproductislistedalthoughseveralmanufacturers maymarketotherbrandnames.
‡Cefadroxil(Duricef®),Cefprozil(Cefzil®),Cephalexin.
REFERENCESLuttersM,Vogt-FerrierNB.Antibioticdurationfortreatinguncomplicated,symptomaticlowerurinarytractinfectionsinelderlywomen.CochraneDatabaseSystRev.2008Jul16;(3):CD001535.WarrenJW,AbrutynE,HebelJR,etal.Guidelinesforantimicrobialtreatmentofuncomplicatedacutebacterialcystitisandacutepyelonephritisinwomen.ClinInfectDis.1999;29:745-58.Please note that other references have been consulted.
Urinary Tract Infections in AdultsThisguidewasdevelopedwiththecollaborationoftheprofessionalcorporations(CMQ,OPQ),thefederations(FMOQ,FMSQ)andQuébecassociationsofpharmacistsandphysicians.
Acute pyelonephritis (APN)
• Inpatientscapableoftakingoraltherapy:- Fluoroquinolonesconstitutefirst-lineempiricaltherapy.- Pregnancymustbeexcludedinwomenofchildbearingage.
• InsevereAPNcasesrequiringhospitalization:- OralorparenteralfluoroquinoloneOR- CombinationofaminoglycosideORextended-spectrumcephalosporinWITHampicillinifenterococcusissuspected.
• DurationoftherapyforAPNis14days;initiateoraltherapyassoonaspossible.• Thepresenceorpossibilityofurinarytractobstructionisconsideredanemergency.
Treatment of uncomplicated urinary tract infections*
Antibiotic† Oral dosage Duration
Fluoroquinolone
Ciprofloxacin(Cipro®) 250mgevery12hours
3 days
CiprofloxacinXL(CiproXL®) 500mgevery24hours
Levofloxacin(Levaquin®) 250mgevery24hours
Norfloxacin(Norflox®generic) 400mgevery12hours
Ofloxacin(Oflox®generic) 200mgevery12hours
Sulfonamide
TMP-SMX(SeptraDS®generic) 1tab.every12hours
TMP(Apo-Trimethoprim®) 100mgevery12hours
Other
Nitrofurantoin(Macrobid®) 100mgevery12hours
7 days
Nitrofurantoin(Novo-Furantoin®) 50-100mgevery6hours
β-lactams
Amoxicillin-clavulanatepotassium(Clavulin®) 250mgevery8hoursor 500mgevery12hours
Narrowspectrumcephalosporins‡ex.:Cefadroxil(Duricef®)
500mgevery12hours
Treatment of acute pyelonephritis and complicated urinary tract infections*
Antibiotic† Dosage Duration
Oral therapy14DAYSEXCEPT:Youngwomenwithoutanatomicalabnormalityoftheurinarytracttreatedwithfluoroquinolones,inwhichcase:7days
Ciprofloxacin(Cipro®) 500mgPOevery12hours
CiprofloxacinXL(CiproXL®) 1000mgPOevery24hours
Levofloxacin(Levaquin®) 500mgPOevery24hours
Parenteral therapy (severe cases)
Initiateoraltherapyassoonaspossible
Ciprofloxacin(Cipro®) 400mgIVBID
Levofloxacin(Levaquin®) 500mgIVDIE
Aminoglycoside+ampicillinORExtended-spectrumcephalosporin+ampicillin