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Prikvačeni tweet
“Mandell Part I: Basic Principles”
A collection of the first tweet from each chapter's thread for easy reference!https://twitter.com/i/moments/1207901116316303360 …Hvala. Twitter će to iskoristiti za poboljšanje vaše vremenske crte. PoništiPoništi -
Hillary Hunsinger, DO proslijedio/la je Tweet
My patients have had a hard time finding it OTC. Only commercially available form I know is mixed with sodium salicylate (“Azo Urinary Tract Defense”). I have avoided recommending in setting of patients taking other NSAIDs.
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Hillary Hunsinger, DO proslijedio/la je Tweet
Seen it few times. Didn’t f/u long enough to gauge accuracy. Seemed well tolerated tho. RTCs — in as much as there r any — suggest only limited short term benefit.
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Hillary Hunsinger, DO proslijedio/la je Tweet
I've used it more than a few times with patients with true recurrent UTIs that don't have good oral options available (allergies, MDROs, etc). Ensuring they are true UTIs and not asymptomatic bacteriuria is critical. Vit C and monitoring urine pH too.
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Methenamine is only used for prophylaxis of recurrent UTIs, not for active cystitis or pyelonephritis But it is not as effective as TMP-SMX or nitrofurantoin for prophylaxis I've never seen it used...anyone else used it?? 14/14
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Conversion is determined by pH and killing by concentration of & time of exposure to formaldehyde...so cannot be used in catheterized patients because the bladder is emptied too quickly Dosing for renal insufficiency is unknown. Don't use in liver failure due to ammonia 13/14
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Methenamine is converted to ammonia and formaldehyde in the acidic environment of urine Formaldehyde denatures
nucleic acids and proteins
No resistance, but Proteus may make urine alkaline due to urease, so methenamine is not converted
12/14Prikaži ovu nitHvala. Twitter će to iskoristiti za poboljšanje vaše vremenske crte. PoništiPoništi -
Increasingly used for ESBL and KPC producing Enterobacteriaceae. In these cases, it can be dosed q48-72h Resistance has been noted to be increasing with increasing usage Should not be used for pyelonephritis Approved for use during pregnancy 11/14
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Broad-spectrum activity against Staph, Enterococcus, most enterics esp E. coli, including almost all ESBL E. coli. Klebsiella, Enterobacter, Serratia, Pseudomonas are variably susceptible Achieves high levels in the urine for >24 hours, allowing 1x dosing 10/14
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Most resistance is chromosomal and is due to blocking this transport, but also plasmid-mediated enzymes that break its oxirane ring:
fosA in Pseudomonas,
fosB in S. aureus
fosX in Listeria
US: PO
Europe: IV
9/14Prikaži ovu nitHvala. Twitter će to iskoristiti za poboljšanje vaše vremenske crte. PoništiPoništi -
Fosfomycin is a member of the "phosphonic" class (the only member?) It blocks cell wall synthesis by inhibiting synthesis of peptidoglycan (NAM)--a different mechanism than beta-lactams. It requires two enzymes to transport it across the cell wall 8/14
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Hepatitis can occur with pulmonary reactions. Also can be acute or chronic and can lead to cirrhosis and death Peripheral neuropathy can occur especially in patients with renal insufficiency Most common is nausea, more common than with other first line UTI abx 7/14
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AEs: pulm rxn
Acute: hypersensitivity pneumonitis, lower lobe infiltrates, eosinophilia, usually reversible
Chronic: occurs with long tx, rare, insidious, easily misdx'd, interstitial infiltrates, fibrosis, may improve with d/c of drug but often persistent, may be fatal
6/14Prikaži ovu nitHvala. Twitter će to iskoristiti za poboljšanje vaše vremenske crte. PoništiPoništi -
Nitro is equivalent to 3 days of TMP-SMX or cipro or 1 day of fosfomycin. With 3 day course, there is persistence of the pathogen in periurethral, vaginal and rectal areas, so a 5 day course is standard Can also be used for prophylaxis (daily or postcoital) at a
dose
5/14Prikaži ovu nitHvala. Twitter će to iskoristiti za poboljšanje vaše vremenske crte. PoništiPoništi -
Excreted by glom filtration and tubular secretion. Excretion is reduced proportionally in renal insufficiency...package insert says not to use if CrCl <60, American Geriatrics Society says CrCl <30 Used for first line therapy for acute uncomplicated cystitis 4/14
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S. aureus and S. saprophyticus are usually susceptible, and it is increasingly used for Enterococcus, including VRE At tolerated oral doses, nitro achieves adequate levels only in the urine, often 50-250, well above MIC breakpoint of 32
Kidney
Prostate
3/14Prikaži ovu nitHvala. Twitter će to iskoristiti za poboljšanje vaše vremenske crte. PoništiPoništi -
Resistance is uncommon, likely due to multiple sites of action. E. coli lacking the enzyme that metabolizes it can show some resistance Proteus, Serratia, and Pseudomonas have inherent resistance; Klebsiella and Enterobacter are often resistant 2/14
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Mandell ch. 37: Nitrofurantoin seems to have multiple sites of action in the
cell, including ribosomes, DNA, and Krebs cycle. It's metabolized by
enzymes into a highly reactive intermediary, which frankly sounds like a bull in a china shop
1/14
#idtwitter#idmededPrikaži ovu nitHvala. Twitter će to iskoristiti za poboljšanje vaše vremenske crte. PoništiPoništi -
My snake Eponine is very interested in learning about antibiotics! She's actually very academic!
#IDtwitterpic.twitter.com/9P1xZKCJoI
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The further I get into ID fellowship, the more I feel like my motto is, "yeaaahh, you should probably tap that..." [Joint, eye, spinal fluid, pleural effusion, pericardial effusion, abscess, etc]
#idtwitterHvala. Twitter će to iskoristiti za poboljšanje vaše vremenske crte. PoništiPoništi -
Additional info on the new drugs
https://twitter.com/IDstewardship/status/1222339123123453953 …Hvala. Twitter će to iskoristiti za poboljšanje vaše vremenske crte. PoništiPoništi
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