Renal- UTI's
                                ============
þ Fluoroquinolone Resistance:
 - Resistance of coliforms is so high now (40-60%) that Dr. Hank Freedy of the
   Mercy Pharmacy (12/05) recommends using Bactrim instead of Cipro for Pyelo,
   and recommends adding a single daily dose of Gent prior to discharge,
   regardless of creatinine/renal function.
 - Usual dose of IV Bactrim is 300 mg for a 70 kg adult (based on
   trimethoprim component) BID

þ Hemorrhagic Cystitis
  <Urol.TXT -hemorrhagic>

þ UTI Treatment
 - Daily cost of IV treatment [Mercy Pharmacy and Therapeutics Update, Jan/Feb
   1998]
  + Unasyn      $50.00
  + Amp+Gent    $3.75
  + Bactrim     $6.00 (8-10 mg/kg trimethoprim divided QID-BID; 80mg/5cc)
  + Rocephin    $22.00
  + Cipro       $36.00
 - Also note that only 75% of E. coli at Mercy is susceptible to Unasyn,
   compared to 90% for IV Bactrim
 - cost of PID treatment:
  + 14 days of Bactrim:  <$20
  + 7 days of Cipro (250 BID): $76 (June 2000); about $15 more for 500 BID
 - Oral cephalosporins have high relapse relase rate compared with Bactrim for
   UTI's.
 - Simple UTI:
  + Bactrim is better than all beta lactams
  + 3 days optimum to balance cure rate against side effects ref 1 [Norby 25]
 - Nursing home patient with UTI: worry about Cipro-resistant Pseudomonas.
 - The Australians use trimethoprim without sulfamethoxasole.
   <R-TMP.TXT>
 - Position Statement on UTIs and Pyelo
   [Warren JW, Abrutyn E, Hebel JR, et al. Guidelines for antimicrobial
   treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis
   in women Clin Infect Dis 1999; 29 745-58,]
   <UTI-pos.txt>

þ Pyelo:
 - Complicated Outpatient Pyelo:
  + quinolones more effective than Bactrim.
    quinolones get into prostate better than Bactrim
  + can treat initially with:  ceftriaxone, Cefonicid 1g, or Gent 2 mg/kg
    then Bactrim or Noroxin 400 BID or Cipro 500 BID
  + With Pyelo, takes 3-4 days for sx including fever to go away.
    [Johnson JR, Lyons MFd, Pearce W, et al. Therapy for women hospitalized
    with acute pyelonephritis: a randomized trial of ampicillin versus
    trimethoprim-sulfamethoxazole for 14 days J Infect Dis 1991;163:325-30.]
    Abstract: <UTIA.TXT -ampicillin>
  + Seven days of Cipro better than two weeks of Bactrim
    [Talan DA, Stamm WE, Hooton TM, et al. Comparison of ciprofloxacin (7
    days) and trimethoprim-sulfamethoxazole (14 days) for acute uncomplicated
    pyelonephritis pyelonephritis in women: a randomized trial. JAMA
    2000;283:1583-90.]
    Abstract: <UTIA.TXT -Cipro>

þ Cranberry Juice and Lactobacillus
 - <Cranbery.TXT>