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Skin and Soft Tissue/UTI Essays

NSG-533-IKC – Advanced Pharmacology

 

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    • View profile card for Kathryn Mosholder
    • Last post Oct 25, 2020 11:03 PM by Kathryn Mosholder
    • Lala, V., & Minter, D. (2020). Acute cystitis. NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK459322/
    • Gauthier, A. (2017). Nitrofurantoin (MACROBID) vs. Trimethoprim/ sulfamethoxazole in women with acute uncomplicated cystitis [PDF]. RxFiles. https://www.rxfiles.ca/rxfiles/uploads/documents/Nitrofurantion-5day-vs TMP-SMX-3day-Trial Summary.pdf
    • Nitrofurantoin 100 mg BID (guidelines state 5 days, scenario says 7 days) is recommended as an appropriate choice for first-line therapy due to minimal resistance and propensity for collateral damage (Gupta et al., 2011).  It is indicated that trimethoprim-sulfamethoxazole 160/800mg BID for 3 days shows comparable efficacy and would also be appropriate, so long as local resistance rates of uropathogens do not exceed 20% for acute uncomplicated cystitis (Gupta et al., 2011). Both of these medication regimens are listed as A-I, meaning they have good evidence to support a recommendation for their use from at least one properly randomized, controlled trial (Gupta et al., 2011). In a study comparing the efficacy of nitrofurantoin for 5 days and trimethoprim/sulfamethoxazole for 3 days in women with acute, uncomplicated cystitis, it was found that both medication regimens were equally efficacious, had similar cure rates, and had similar rates of adverse events (Gauthier, 2017). However, Gupta et al. (2011) indicate that though trimethoprim-sulfamethoxazole is a traditional first-line agent in the United States, rising rates of resistance among uropathogens correlating to clinical failures has led to the European Association of Urology to remove this medication as a first-line choice for the treatment of uncomplicated cystitis. Additionally, it was mentioned that trimethoprim is among the antimicrobials that affect normal fecal flora more significantly, leading to increased rates of antimicrobial resistance, whereas nitrofurantoin has shown to preserve in vitro susceptibility to E. coli, causing minimal collateral damage (Gupta et al., 2011). Therefore, in order to reduce the risk of potential for collateral damage, I would recommend nitrofurantoin for this patient.
    • Cystitis TreatmentSubscribe
    • Kathryn Mosholder posted Oct 21, 2020 11:13 PM
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    • The case this week is a 31 yr old woman suffering from Acute Uncomplicated Cystitis with a urine culture positive for susceptible E. coli. The first option of nitrofurantoin 100 mg PO BID x 7 days safety and efficacy concerns whether renal functions are changing or unstable. Metabolites can accumulate, causing renal insufficiency or leading to neuropathy avoid if CrCl < 30ml /min (Chisholm-Burns et al., 2019). As far as efficacy, it is not considered to be the most effective for E. Coli. But it is the first line treatment for oral antibiotics for actue cystitis (Chisholm-Burns et al., 2019). The second option for treating this patient is  TMP/SMX DS (160 mg/800 mg) PO BID x 3 days regarding safety and efficacy; it is the number one choice for E. Coli Infections (Chisholm-Burns et al., 2019). It also is affordable, has a low reaction rate, and is very effective at fight UTI infections (Chisholm-Burns et al., 2019). The third choice is levofloxacin 250 mg PO daily x 3 days. It is considered safe in most patients but not for pregnant or pediatric patients (Chisholm-Burns et al., 2019).  Levofloxacin is most affective for pyelonephritis if E. Coli resistance is <10% in the area (Chisholm-Burns et al., 2019). The fourth choice is cephalexin 500 mg PO q12hrs x 7-14 days. It is considered safe for patients and is deemed safe for oral antimicrobial therapy, and is acceptable continuous prophylaxis for six months every 24 hours (Chisholm-Burns et al., 2019). This patient does not need prophylaxis at this time per the case study guidelines. ReferencesMarkowitz, M. A., Wood, L. N., Raz, S., Miller, L. G., Haake, D. A., & Ja-Hong, K. (2019). Lack of uniformity among United States recommendations for diagnosis and management of acute, uncomplicated cystitis. International Urogynecology Journal, 30(7), 1187-1194. http://dx.doi.org.wilkes.idm.oclc.org/10.1007/s00192-018-3750-zless1 UnreadUnread8 ViewsViews
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    • View profile card for Candace Whitman-Workman
    • Last post Oct 25, 2020 7:33 PM by Candace Whitman-Workman
    • McIsaac, W.J., Moineddin, R., Gágyor, I. et al. External validation study of a clinical decision aid to reduce unnecessary antibiotic prescriptions in women with acute cystitis. BMC Fam Pract 18, 89 (2017). https://doi.org/10.1186/s12875-017-0660-y
    • Chisholm-Burns, M. A., Schwinghammer, T. L., Malone, P. M., Kolesar, J. M., Bookstaver, P. B., & Lee, K. C. (2019). Pharmacotherapy principles & practice. McGraw-Hill Education.
    • I would choose the Nitrofurantoin 100mg  every 12 hrs for seven days since it is recommended as the first drug choice for oral medication, and this patient is young and does not have compromised kidneys. (McIsaac et al., 2017) Studies show that more patients are poorly managed and need appropriate urine analysis and testing before being prescribed antibiotics (McIsaac et al., 2017). The VA is starting to track certain antibiotics to ensure they are not overused to develop more resistance. ). the VA is beginning to follow certain antibiotics to make sure they are not being overused for patients to develop more excellent resistance.Trimethoprim-sulfamethoxazole, Fosfomycin, and nitrofurantoin are acceptable first-line treatment by all; however, some societies recommend antibiotic with a high instance of resistance. Due to these inconsistencies, more research and a standardized care document need to be determined (Markowitz et al., 2019).
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    • Carlita Lockett posted Oct 18, 2020 5:51 PM
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    • Drug Dose/Frequency Safety Efficacy Price per subscription
      Nitrofurantoin 100mg po BID x 7 days Moderate drug interactions Effective for E. coli $16.95 for 14 capsules or $16.95 total
      TMP/SMX DS 160mg/800mg po BID x 3 days Moderate drug interactions Reduced effectiveness for E. coli $7 for 20 tablets or $2.10 total
      Levofloxacin 250mg po daily x 3 days Moderate drug interactions Effective for E. coli $3.32 for 10 tablets or $0.99 total
      Cephalexin 500mg po q 12hrs x 7-14 days Moderate drug interactions Effective for E. coli $4.59 for 28 capsules or $2.29- $4.59 total

      ** TMP/SMX = Trimethoprim/Sulfamethoxazole        TMP/SMX DS is used to treat UTI’s.  It has similar efficacy, but not necessarily the amount of safety as the other antibiotics to treat cystitis. Gastrointestinal and hepatic adverse events are reported with the use of this antibiotic (Asmar et al., 2017).  Those two adverse events are significant because they can cause absorption issues with other medications.  International surveillance reports of increasing resistance rates of community-acquired E. coli to trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolones (FQs), and other frequently used drugs for the treatment of UTI are mostly derived from the laboratory- and hospital-based collection of urinary isolates (Alejandria et al., 2015). This drug is cost-effective and has a short duration period which would lead to being more compliant, but based on the research TMP/SMX DS is not as effective in reducing E.coli as the other medications presented.  I would not choose this drug over the other antibiotics.            An antibiotic similar to Cephalexin would be given as a first-line treatment medication.   Treatment approaches may be local (directed to the bladder) or systemic, range from behavioral to pharmacological, and may include many types of adjunctive therapy approaches intended to optimize the quality of life (Erikson et al., 2015).  Cephalexin has the longest duration period which would likely lead to non-compliance. It is almost the cheapest antibiotic and has the efficacy and safety of the other antibiotics.  I would not choose this because of the duration period is too long compared to other antibiotics. Alejandria, M., Alfaraz, L., Ata, R.M., Gangcuangco, L.M., Henson, K.E., & Saniel, M. (2015). among women with acute uncomplicated urinary tract infection in a developing country.https://doi.org/10.1016/j.ijid.2015.02.022Sulfamethoxazole-induced hepatoxicity in a renal transplant patient.  Indian Journal ofhttps://doi.org/10.4103/ijn.IJN_339_16https://www.ncbi.nlm.nih.gov/books/NBK470526/#_NBK470526_pubdet_interstitial cystitis/bladder pain syndrome: AUA guideline amendment.  The Journal ofhttps://doi.org/10.1016/j.juro.2015.01.086

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    • View profile card for Pawn Johnson-Hunter
    • Last post Oct 25, 2020 4:45 PM by Pawn Johnson-Hunter
    • Urology,193(5), 1545-1553.
    • Erikson, D., Faraday, M.M., Hanno, P.M., & Moldwin, R. (2015).Diagnosis and treatment of
    • del Portal, D. & Squadrito, F.J. (2020, July 10). Nitrofurantoin.
    •  Nephrology, 27(6), 482-483.
    • Asmar, N., Chelala, D., Honeinm, K., Sayegh, R., & Slim, R. (2017).  Trimethoprim-
    •  International Journal of Infectious Diseases, 34, 55-60.
    • Prevalence and risk factors for trimethoprim-sulfamethoxazole-resistant Escherichia coli
    •                                                                      References:
    •          Levofloxacin is generally used for diarrhea caused by E. coli but can be just as effective as other antibiotics for the treatment of cystitis.  The cost of Levofloxacin is the lowest of all the other antibiotics.  It also has the shortest duration period which strongly increases the likelihood of compliance.  The drug interactions are the typical interactions expected when taking an antibiotic.  I would choose this drug based on the safety, efficacy, and costs associated with it.
    •        The diagnosis of uncomplicated cystitis is a common diagnosis for a 31-year-old female.  Many common antibiotics could be used to treat this disorder.  Some antibiotics have been proven to become resistant to E. coli.  Resistance to nitrofurantoin remains relatively rare despite several decades of widespread use (del Portal & Squadrito, 2020).  This drug has similar safety concerns to the antibiotics in comparison.  It would also work just as well if given to the patient as the other medications.  Nitrofurantoin is the most expensive of the drugs listed, so I would not choose it over the rest because of the cost and duration period the medication has to be taken.
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    • Pawn Johnson-Hunter posted Oct 22, 2020 12:09 AM
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    •  The resistance rate is not known from the case study; also, the drug is category D, which can potentially risk a fetus with pregnancy unknown and HT being of childbearing age.    Antibiotic Susceptibility Testing. (2019, December 31). https://labtestsonline.org/tests/antibiotic-susceptibility-testing.Gupta, K., Hooton, T. M., Naber, K. G., Wullt, B., Colgan, R., Miller, L. G.,Soper, D. E. (2015, March 1). International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Validate User. https://academic.oup.com/cid/article/52/5/e103/38828 less1 UnreadUnread6 ViewsViews
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    • View profile card for Shante Hunt
    • Last post Oct 25, 2020 4:40 PM by Shante Hunt
    • Robinson, T. F., Barsoumian, A. E., Aden, J. K., & Giancola, S. E. (2019;2020;). Evaluation of the trends and appropriateness of fluoroquinolone use in the outpatient treatment of acute uncomplicated cystitis at five family practice clinics. Journal of Clinical Pharmacy and Therapeutics, 45(3), 513-519. doi:10.1111/jcpt.13099
    • Colgan, R., & Williams, M. (2011, October 1). Diagnosis and Treatment of Acute Uncomplicated Cystitis. https://www.aafp.org/afp/2011/1001/p771.html.
    • References
    • Levofloxacin, a fluoroquinolone also not chosen due to the increasing rate of resistance, potential category C harm, and high risk for renal damage. Although fluoroquinolones (FQs) (ciprofloxacin, levofloxacin) are highly effective for uncomplicated cystitis, they are considered alternatives due to their high propensity for collateral damage (Robinson et al., 2020). Fluoroquinolone resistance is usually below 10 percent in North America and Europe, but with a trend toward increasing resistance over the past several years (Colgan & Williams, 2011). Cephalexin, a B-lactams, is safe for use if HT is pregnant, and the drug is considered first-line; however, it may not be as effective. Nitrofurantoin monohydrate/macrocrystals is an appropriate choice for therapy (nitrofurantoin 100 mg po BID x 7 days) due to minimal resistance and propensity for collateral damage (Gupta et al., 2015).
    • When identifying the appropriate antibiotic therapy for a patient, the provider should review the lab results to determine drug susceptibility. According to the American Association for Clinical Chemistry, testing is used to determine the potential effectiveness of specific antibiotics on the bacteria to determine if bacteria have developed resistance to certain antibiotics; the results can be used to help select the drug that will likely be most effective in treating an infection (2019). Diagnostic testing presenting symptoms and patient history is essential to prescribing the safest and most effective treatment. Acute cystitis is one of the most common urinary tract infections affecting women with Escherichia coli (E. coli) identified as the number one cause of the condition. When reviewing the possible treatment therapies in the case study, trimethoprim-sulfamethoxazole would not be chosen due to increasing antimicrobial resistance.
    • Module VIII Discussion Post
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    • Gisselle Mustiga posted Oct 22, 2020 12:06 AM
    • Acute uncomplicated cystitis refers to a urinary tract infection in women with no pregnancies and those not past their menopausal phase (Gupta et al., 2011). This condition presents itself with symptoms like frequent urges to urinate, hematuria, and dysuria. Its diagnosis primarily relies on the patient’s history (Colgan & Williams, 2011). The most common treatment option includes antibiotics because of their higher therapeutic rates and prevention capabilities. Nonetheless, these drugs may have adverse effects on one’s guts or create an imbalance in the female reproductive system. Some of the medications include nitrofurantoin, TMP/SMX, levofloxacin, and cephalexin.The third drug works by preventing bacterial multiplication. Levofloxacin is significant as it supports the treatment of infections that may be resistant to other antibiotics. However, this drug can cause the rupture of tendons due to its fluoroquinolone nature. The last antibiotic in the list is efficient as it prevents the development of a bacterial wall around cells, and hence the bacteria die off. Nevertheless, this medication may cause seizures and is not advisable for individuals who are allergic to penicillin.ReferencesColgan, R., & Williams, M. (2011). Diagnosis and treatment of acute uncomplicated cystitis. American family physician, 84(7), 771-776. less0 UnreadUnread
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    • View profile card for Augusta Ibeh
    • Last post Oct 25, 2020 3:27 PM by Augusta Ibeh
    • Gupta, K., Hooton, T. M., Naber, K. G., Wullt, B., Colgan, R., Miller, L. G., … & Soper, D. E. (2011). International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clinical infectious diseases, 52(5), e103-e120.
    • This analysis proves that all these drugs are pivotal in the management of acute uncomplicated cystitis. However, based on the dosage, the best option for HT would be the first-line treatment choices: nitrofurantoin and the TMP/SMX. She should then opt for the latter since it has the least side effects and limited therapy duration.
    • The first drug is essential as it works by averting the increase in bacteria. It is also safe for both expectant and lactating mothers as long as their health providers prescribe the right dosage. Very few people report having side effects to the use of this drug. Nonetheless, prolonged reliance on nitrofurantoin may cause lung problems. The second drug is considered one of the most effective treatments for managing acute uncomplicated cystitis due to minimal consequences and suitability for patients with sulfur allergies. Most importantly, the drug component makes it easy to treat upper tract infections as well.
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    • Augusta Ibeh posted Oct 20, 2020 9:52 PM
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    •              Uncomplicated cystitis is the absence of anatomical or functional abnormalities while complicated cystitis involves the anatomical structures or systemic factors that increase the chance of infection like male gender, diabetes, immunosuppression, polycystic kidney, hospital-acquired, bladder outflow obstruction (prostate hypertrophy, urethra stricture), neuropathic bladder, (multiple sclerosis, diabetes mellitus) catheterization or ureter stent, ureterolithiasis, genitourinary surgery or malignancy, vesicoureteral reflux Lala et al., (2020).            The guideline recommendation for treatment od acute non complicated cystitis and pyelonephritis are different from country to country, the preferred antibiotics availabilities and costs. Some countries prefer to use Trimethoprim 100mg twice daily for 3 days (A11) group for the treatment of acute cystitis compared to trimethoprim-sulfamethoxazole which is under A1 in the guideline Warren et al., (1999). On the guideline, the number one treatment for uncomplicated treatment of acute cystitis are:            Using the guideline established for the treatment of acute cystitis, I will choice Trimethoprim-sulfamethoxazole (160/800 mg) Bactrim DS twice daily for 3 days. It is cheap in terms of price, tolerable, takes 3 days to eradicate the causative microorganism and less side effects and under group A-1 on the treatment guideline.            Even though levofloxacin 250 mg orally daily for 3 days is under group A-1, but it has propensity for collateral damage such as tendon problems, nerve damage, serious mood or behavior changes or low blood sugar Drug.com (n.d.).
      Drug Nitrofurantoin 100mg BID for 7 days TMP/SMX DS 600/800 mg twice daily for 3 days Levofloxacin 250 mg daily for 3 days Cephalexin 500 mg every 12 hrs. for 7-14 days
      Safety A-1 A-1 A-1 B-1
      Efficacy appropriate & effective appropriate & effective effective but has propensity for collateral damage poor

      Amelia E. Barber, J. Paul Norton, Adam M. Spivak, Matthew A. Mulvey, Urinary Tract   Infections: Current and Emerging Management Strategies, Clinical Infectious Diseases,           Volume 57, Issue 5, 1 September 2013, Pages 719–        724, https://doi.org/10.1093/cid/cit284Lala V, Minter DA. Acute Cystitis. [Updated 2020 Jul 10]. In: StatPearls [Internet]. Treasure       Island (FL): StatPearls Publishing; 2020 Jan-. Available from:     https://www.ncbi.nlm.nih.gov/books/NBK459322/Warren, J., Abrutyn, E., Hebel, J., Johnson, J. R., Schaeffer, A., & Stamm, W. (1999, January      01). [PDF] GUIDELINES FROM THE INFECTIOUS DISEASES SOCIETY OF       AMERICA Guidelines for Antimicrobial Treatment of Uncomplicated Acute Bacterial            Cystitis and Acute Pyelonephritis in Women: Semantic Scholar. Retrieved from   https://www.semanticscholar.org/paper/GUIDELINES-FROM-THE-INFECTIOUS-  DISEASES-SOCIETY-OF-Warren-            Abrutyn/36a96204086bd9cbb4b547bbf1461a0c23ab80ff less1 UnreadUnread9 ViewsViews

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    • View profile card for Augusta Ibeh
    • Last post Oct 25, 2020 2:06 PM by Augusta Ibeh
    • Levofloxacin Uses, Side Effects & Warnings. (n.d.). Retrieved from             https://www.drugs.com/mtm/levofloxacin.html
    • Kalpana Gupta, Thomas M. Hooton, Kurt G. Naber, Björn Wullt, Richard Colgan, Loren G.         Miller, Gregory J. Moran, Lindsay E. Nicolle, Raul Raz, Anthony J. Schaeffer, David E. Soper, International Clinical Practice Guidelines for the Treatment of Acute       Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious     Diseases Society of America and the European Society for Microbiology and Infectious Diseases, Clinical Infectious Diseases, Volume 52, Issue 5, 1 March 2011, Pages e103–    e120, https://doi.org/10.1093/cid/ciq257
    • Reference
    • Obtained from: International Clinical Practice Guidelines for the Treatment of Acute        Uncomplicated Cystitis and Pyelonephritis in Women Kalpana et al., (2011).
    • Cephalexin 500 mg po every 12 hour for 7-14 days is in group B-1 in the treatment guideline for the treatment of cystitis and the efficacy is recorded poor. Cephalexin should not be considered in the treatment of cystitis Kalpana et al., (2011).
    •             Nitrofurantoin is also under group A-1 for treatment of cystitis but must be taken for 7 days for it to eradicate the symptoms of cystitis.
    •             Nitrofurantoin monohydrate/macrocrystals (100 mg orally twice daily for 5 days) A-1 group. It recorded as the appropriate therapy with minimal resistance and damage. Its effectiveness is compared with 3 days trimethoprim-sulfamethoxazole (160/800 mg) 1 double strength daily for 3 days (A-1).
    •             The guideline for treatment and diagnosis of acute uncomplicated cystitis and pyelonephritis focused on premenopausal, nonpregnant women with no renal abnormalities or comorbidities and postmenopausal women that have no urinary tract complication and diabetes that their blood sugars are under control. The prevention of recurrent cystitis, UTI in pregnant women, are not included in the current guideline Kalpana, Thomas, Hurt, Bjorn, Richard, Loren, Miller, Gregory, Lindsay, Raul, Anthony, & David (2011).
    •             Acute cystitis is one of the most seen bacterial infections and is responsible for substantial morbidity and high medical costs in United States and the world Amelia, Paul, Adam, & Matthew (2013). Women suffer urinary tract infection more and the common organisms usually Escherichia coli (86%), and Staphylococcus saprophyticus (4%). The diagnosis of uncomplicated cystitis is made by obtaining history, physical examination and urinalysis Lala & Minter (2020). Cystitis can be classified as uncomplicated or complicated, workup, as well as the treatment is guided by the classification Lala & Minter (2020).
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    • Shante Hunt posted Oct 21, 2020 5:35 PM
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    • Acute uncomplicated cystitis is a commonly diagnosed infection and sometimes over-treated.  Acute uncomplicated cystitis in women is diagnosed more frequently in women and is defined as “symptomatic bladder infection without structural abnormalities, urinary instrumentation, or systemic diseases such as immunodeficiency” (Datta and Juthani-Mehta, 2018).    Sulfamethoxazole/Trimethoprim. https://www.goodrx.com/sulfamethoxazole-trimethoprim?dosage=800mg-160mg&form=tablet&label_override=sulfamethoxazole+%2F+trimethoprim&quantity=6less1 UnreadUnread4 ViewsViews
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  • View profile card for Jessica Faltinowski
  • Last post Oct 22, 2020 3:33 PM by Jessica Faltinowski
  • GoodRx.com. Nitrofurantoin Mono/Macro. https://www.goodrx.com/nitrofurantoin-mono-macro?c=homepage-lander-sem-6&gclid=EAIaIQobChMIjp3Y-s7G7AIVQfSzCh1RnQuAEAAYASAAEgKv0_D_BwE
  • Datta, R., & Juthani-Mehta, M. (2018). Nitrofurantoin vs. Fosfomycin: Rendering a verdict in a trial of acute uncomplicated cystitis. JAMA: Journal of American Association, 319(17), 1771-1772. http://dx.doi.org.wilkes.idm.oclc.org/10.1001/jama.2018.4654
  • Chardavoyne, P. & Kasmire, K. (2020). Appropriateness of antibiotic prescriptions for urinary tract infections. Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, 21(3), 633-639. http://dx.doi.org.wilkes.idm.oclc.org/10.5811/westjem.2020.1.45944
  • References:
  • HT is a 31 year old, otherwise healthy female with symptoms consistent with uncomplicated cystitis and based on the choices in the case study, I would select TMP/SMX DS (160 mg/800 mg) by mouth twice daily for three days. There is some evidence that common urinary tract organisms that cause infection are showing resistance to TMP/SMX (Chardavoyne and Kasmire, 2020), there is still documented efficacy with this treatment regimen.  A close second choice would be nitrofurantoin 100 mg twice daily for five to seven days (Datta and Juthani-Mehta, 2018), however the length of the required treatment concerns me as some patients discontinue treatment once they begin to experience resolution of symptoms.  Additionally, the cost of treatment with nitrofurantoin for 7 days is $19 compared to a 3 day course of TMP/SMZ DS which would cost $7 using a discount card that is free for patients to use (goodrx.com).
  • Module VIII – Candace Whitman-Workman
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  • Candace Whitman-Workman posted Oct 21, 2020 7:01 PM
  • I have been tasked to choose best treatment for HT, a 31 year old female with acute, uncomplicated cystitis and no known drug allergies, using a provided list of medications in which the UTI is sensitive.  See table below for comparative safety and efficacy in listed medications.  In thinking back to last week, the least complicated drug regimen is ideal.  Giving improved compliance with uncomplicated, short treatment options, my first two choices would be TMP/SMX DS (160mg/800mg) PO BID x3 days or levofloxacin 250mg PO daily x3 days.  However, also in thinking back to last week, I would eliminate levofloxacin, although highly effective, per Chisolm-Burns, et al. (2019) from my first line treatment options to avoid potentially serious drug to drug interactions and to minimize the development of antibiotic resistant bacteria.  Fluoroquinolones should also “not be used empirically for acute cystitis due to the risk of collateral damage, unless a first-line agent cannot be used” (Chisolm-Burns, et al., 2019, p. 1200).  Should TMP/SMX DS regional resistance rates is greater than 20%, I would eliminate this choice and prescribe nitrofurantoin 100mg po BID, however, I would choose a five (5) day course rather than a seven (7) day course.
    Drug Safety Efficacy
    nitrofurantoin 100 mg po BID x 7 days Low risk of collateral damage.  Avoid use in situations where creatinine clearance is less than 60ml/min, but some evidence states 30ml/min., recommended treatment 5 days of antibiotic therapy Broad spectrum, Generally effective for treatment and prophylaxis in acute cystitis.  Does not penetrate renal tissues well, therefore ill effective in pyelonephritis
    TMP/SMX DS (160 mg/800 mg) po BID x 3 days Well tolerated, avoid in those with sulfa allergies, monitor regional drug resistance rates Inexpensive, effective for treatment and prophylaxis
    levofloxacin 250 mg po daily x 3 days High risk of collateral damage, increased drug resistance, should not be used in pregnancy or with children, Highly effective
    cephalexin 500 mg po q12hrs x 7-14 days Typically mild, but some serious side effects, drug to drug interactions, risk in pregnancy and breastfeeding Effective

    Cephalexin. (2020). Retrieved from Medline Plus: https://medlineplus.gov/druginfo/meds/a682733.htmlGauld, N. J., Gauld, N. J., Zeng, I. S. L., Zeng, I. S. L., Ikram, R. B., Ikram, R. B., . . . Buetow, S. A. (2017). Antibiotic treatment of women with uncomplicated cystitis before and after allowing pharmacist-supply of trimethoprim. International Journal of Clinical Pharmacy, 39(1), 165-172. doi:10.1007/s11096-016-0415-1less0 UnreadUnread

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  • Chisolm-Burns, M. A., S, Schwinghammer, T. L., Malone, P. M., Kolesar, J. M., Lee, J. M., & Bookstaver, P. B. (2019). Pharmacotherapy Principles & Practice (Fifth ed.). McGrraw-Hill Education.
  • References
  • Interestingly, in a 2012 New Zealand study, Trimethoprim 300 mg was permitted to be prescribed by pharmacists to qualifying, non-pregnant women with uncomplicated cystitis without patients seeing a physician.  The treatment lacked the sulfa component, but is considered first line of treatment in New Zealand.  Other countries attempted or considered allowing pharmacists to treat uncomplicated cyctitis, but halted with concerns over increasing drug resistance.
  • Discusssion VIII Skin and Soft Tissue/ UTI
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  • Robin Morgan posted Oct 20, 2020 6:18 PM
  • Module VIII skin and soft tissue/UTIWe are presented with 4 acceptable antibiotic orders for patient HT who has an acute, uncomplicated cystitis caused by E. coli, that is susceptible to all treatment choices. I am going to compare safety and efficacy of the drug choices.
    1. Nitrofurantoin- Nitrofurantoin should be taken with a full glass of water and with meals to avoid GI upset. HT should not skip any doses, and make sure to take all medication until completed. Side effects include dark yellow or brown urine, nausea, vomiting, loss of appetite. Nitrofurantoin is very effective in treating cystitis if directions are followed. HT should start feeling better after 3 days. This drug is safe for pregnant woman.
    2. TMP/SMX DS (Bactrim, Septra)- TMP/SMX DS is a combination antibiotic of Trimethoprim and Sulfamethoxazole. This drug is absorbed with peak levels occurring within one to four hours after taking. The antibacterial effects of Bactrim persist for at least 12 hours. It only has to be taken for 3 days. This drug is highly affective for UTI’s. TMP/SMX DS.  Bactrim has been considered the first line drug for uncomplicated UTI’s for years, this has brought on a high bacterial resistance to TMP/SMX has limited its use to only a few indications(Georgopapadakou, 2000). Sulfa antibiotics can have serious side effects including hypersensitivity or toxic reactions. It is also the most important drug to cause blood dyscrasias. Side effects have reduced the attractiveness of Sulfonamides.
    3. Levofloxacin- Levofloxacin 250 mg PO for three days has proven to be very effective against uncomplicated UTI’s. While resistance of uropathogens to Bactrim appears to have been increasing over the last few years, susceptibility fluroquinolones has remained unchanged. Potential side effects include, constipation, diarrhea, insomnia, dizziness and headache.
    4. Cephalexin- Cephalexin (Keflex) will only kill certain kinds of bacteria, so other types may continue to grow and cause other infections. Keflex is on the World Health Organizations list of Essential Medicines, the safest and most effective medicines needed in a health system. There is a risk for bacterial resistance to cephalexin. This drug should be taken on an empty stomach for maximum benefit. One potentially deadly complication of cephalexin are Stevens-Johnson syndrome and toxic epidermal necrolysis(“Cephalexin,” 2019). Although incredibly rare, we need to be able to recognize these

    complications.After my review my prescription choice would be Levofloxacin for 3 days. Fluroquinolones resistance has remained relatively stable over the years, potential side effects are few and the short duration of dosing makes it more likely to be taken correctly.ReferencesGeorgopapadakou, N. H. (2000). Infectious disease 2000: Drug resistance and new drugs. Drug Resistance Updates, 3(5), 265–269. https://doi.org/10.1054/drup.2000.0168

  • Kramarov, S., & Zakordonets, L. (2018). Antibiotic therapy of acute uncomplicated cystitis. ACTUAL INFECTOLOGY, 6(4), 185–188. https://doi.org/10.22141/2312-413x.6.4.2018.142471
  • Cephalexin. (2019). In Pharmacotherapyfirst drug information. The American Pharmacists Association. https://doi.org/10.21019/pfdi.cephalexin
  •      Antibiotic choices are many, but we as healthcare professional need to be conscious prescribers and look for the shortest duration of antibiotics necessary to improve patients’ infections. Efficacy is important and we may not get the right antibiotic ordered the time. We may have to prescribe a stronger antibiotic for a longer duration, but logically starting with the least and going up just make sence with bacterial resistance among antibiotics today.
  • Although all of these antibiotics could potentially cure for uncomplicated cystitis, I have to analyze the choices and decide on the best course of action for my assigned patient HT. Nitrofurantoin’s would be a good choice, but if HT is not feeling well, it may take up to three days for this drug to work, and it must be taken for 7 days.  TMP/SMX DS has been prescribed so much, many bacteria have built up a resistance to this antibiotic, only taking it for 3 days is a plus, but not if it potentially will not help the patient clear up her UTI. Keflex is relatively safe drug of choice, but not effected on certain types of bacterial causing potential problems with other bacteria that may be causing problems. It also has a potential for bacterial resistance due to it being prescribed regularly for infection. Cephalexin also has to be taken for 7-14 days every 12 hours having the potential for non-compliance. Although rare there are potential to cause some serious side effects.
  • Urinary tract infections are the most common bacterial infections in woman. Most UTI’s are acute uncomplicated cystitis. Symptoms are frequency and dysuria(Kramarov & Zakordonets, 2018). Although acute uncomplicated cystitis may not be thought of as a serious condition, patients’ quality of life is often affected.

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