Best Practice Guidelines for Treatment of Uncomplicated UTIs in Women While Decreasing Risk of Antibiotic Resistance

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Carmella Ray
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1 The Henderson Repository is a free resource of the Honor Society of Nursing, Sigma Theta Tau International. It is dedicated to the dissemination of nursing research, researchrelated, and evidence-based nursing materials. Take credit for all your work, not just books and journal articles. To learn more, visit Item type Format Title Authors Presentation Text-based Document Best Practice Guidelines for Treatment of Uncomplicated UTIs in Women While Decreasing Risk of Antibiotic Resistance Lo-Montano, Romina Downloaded 30-Jun :53:36 Link to item

2 Best practice guidelines for uncomplicated urinary tract infections to reduce rates of antibiotic resistance: A CE module Romina Lo-Montano, DNP, MSN, APN, FNP-C Chair: Diane John, PhD, ARNP, FNP-BC Content Expert: Sally Weiss, PhD, RN, CNE, ANEF

3 Faculty Disclosure Faculty Name Conflict of Interest Name of Employer Sponsorship/Commercial Interest Faculty Name Conflict of Interest Name of Employer Sponsorship/Commercial Interest Faculty Name Conflict of Interest Name of Employer Sponsorship/Commercial Interest Romina Lo-Montano, DNP, MSN,FNP-C None University of Phoenix, AZ None Diane John, PhD, ARNP, FNP-C None Frontier Nursing University, KY None Sally Weiss, PhD, RN, CNE, ANEF None Nova Southeastern University, FL None

4 Session Goal To improve adherence to EBP guidelines for treatment of uncomplicated urinary tract infections in women and to promote antibiotic stewardship.

5 Objectives Participants will be able to: 1. Differentiate between complicated and uncomplicated UTIs. 2. Identify differential diagnoses for UTI symptoms. 3. State first-line of treatment for uncomplicated UTIs according to the latest IDSA guidelines. 4. Practice antibiotic stewardship.

6 Definitions Uncomplicated urinary tract infections (UTIs) Complicated urinary tract infections Interstitial cystitis

7 Statistics in the US UTIs account for 8.6 million visits to PCP offices (Hooton, 2012) Total cost for care, $2.4 billion annually (O Dell, 2011; Barber et al, 2013) Prescription medication costs totaled at $218 million (O Dell)

8 Symptoms Classic UTI symptoms: Dysuria, urinary frequency, urgency, hematuria, odor, suprapubic pain STI symptoms: Dysuria, urinary frequency, vaginal discharge (not always), odor

9 Current trends Empiric treatment is common Antibiotics remain the standard of care Long course of antibiotics (7-10 days)

11 Current Findings Patients tend to self-diagnose Self medication is not uncommon 55% of women are willing to delay antibiotic use. Correlation between expectation & prescribing behavior

12 Misconceptions Antibiotics are needed Antibiotics speed up recovery First case of resistance found in 1940s Untreated UTIs will become kidney infections

13 Urine culture & sensitivity Is it necessary? If so, when?

14 (+) Urinalysis with a (-) Urine C&S? Why? What are your considerations?

15 Other Considerations STD: Chlamydia Anatomical abnormality Low colony count (10 3 CFU/mL vs 10 5 CFU/mL)

16 CDC definition Appropriate use of antibiotic is defined as use that maximizes therapeutic effect while minimizing risk of increased resistance (Nicolle, Anderson, Conly, Mainprize, Meuser, Nickle, Senikas, & Zhanel, 2006, pp. 615).

17 IDSA (2010/11) Recommendations First-line Nitrofurantoin 100mg po bid (x 5 days) Alternate therapy TMP/SMX 160/800mg po bid (x3 days) In case of resistance or allergy to first-line: Ciprofloxacin 250mg po bid (x3 days)

18 Summary Antibiotic resistance is a global problem Practice antibiotic stewardship Educate your patients and colleagues Use shortest effective course of treatment

19 Quote There is the danger that the ignorant man may easily under dose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant. Alexander Fleming, Dec. 11, 1945 at the end of his Nobel lecture

21 References Ansbach, R. K., Dybus, K., & Bergeson, R. (2005). Uncomplicated E. coli urinary tract infection in college women: a follow-up study of E. coli sensitivities to commonly prescribed antibiotics. Journal of American College Health, 54, Barber, A. E., Norton, J. P., Spivak, A. M., & Mulvey, M. A. (2013, September 1). Urinary tract infections: Current and emerging management strategies. Clinical Practice, 57, Dryden, M., Johnson, A. P., Ashiru-Oredope, D., & Sharland, M. (2011, September 15). Using antibiotics responsibly: Right drug, right time, right dose, right duration. Journal of Antimicrobial Chemotherapy. 66, Gupta, K., Hooten, T. M., Naber, K. G., Wullt, B., Colgan, R., Miller, L. G., Soper, D. E. (2010, 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. Clinical Practice Guidelines, 201, e Retrieved from Patient_Care/PDF_Library/Uncomp %20UTI.pdf

22 References Hooten, T. M. ( 2012, March). Uncomplicated urinary tract infection. New England Journal of Medicine. 366, Knottnerus, B. J., Geerlings, S. E., Moll van Charante, E. P., & ter Riet, G. (2013, May 31st). Women with symptoms of uncomplicated urinary tract infection are often willing to delay antibiotic treatment: A prospective cohort study. BMC Family Practice. Nicolle, L., Anderson, P. A., & Zhanel, G. G. (2006, May 10). Uncomplicated urinary tract infection in women. Canadian Family Physician, 52, Retrieved from O Dell, K.K. (2011, May/June). Pharmacological management of asymptomatic bacteriuria and urinary tract infections in women. Journal of Midwifery and Women s Health, doi: /j x

Antimicrobial Stewardship in Continuing Care. Urinary Tract Infections Clinical Checklist

Antimicrobial Stewardship in Continuing Care Urinary Tract Infections Clinical Checklist December 2014 What is Antimicrobial Stewardship? Using the: right antimicrobial agent for a given diagnosis at the