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Abx for STD/UTI?

Discussion in 'Step I' started by Cards21aceking, Jun 17, 2008.

  1. Cards21aceking

    Cards21aceking 5+ Year Member

    Feb 27, 2007
    So, its getting near crunch time and I'm still having difficulty trying to figure out what would be appropriate treatment for either of these scenarios.

    Any thoughts?
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  3. LadyWolverine

    LadyWolverine 10+ Year Member

    Aug 17, 2004
    Hiding in your closet
    Whenever I get a UTI, they give me Bactrim. Except once, when they gave me cephalexin.
  4. djnels01

    djnels01 "You're the man now dog!" Physician 7+ Year Member

    Aug 8, 2005
    I hear cranberry juice works great... just mix in a little Vodka and you're killing two birds with one drink (bacteria + hepatocytes)
  5. MSKalltheway

    MSKalltheway I got the magic stick 7+ Year Member

    Jan 16, 2007
    I'm too tired to be completely sure, but I think TMP-SMX is always a safe bet. I could have sworn I've seen amoxicillin thrown around here and there, but forget that my colleague said, bactrim is 1st line for UTIs.
  6. GynGuy1983

    GynGuy1983 C&A Psychiatry Fellow 7+ Year Member

    Jun 13, 2008
    Rathke's pouch
    TMP-SMX works well in most UTI's, but be careful that they don't have a sulfa drug allergy. For pregnant women, I would recommend ampicillin/sulbactam. C. trachomatis give them azithromycin or ciprofloxacin. N. gonnorrhea - "Tri to Fix a Fox" Basically ceftriaxone, cefixime, cofoxitin.

    I'm too lazy to list the rest.
  7. TerpMD

    TerpMD 2+ Year Member

    Sep 26, 2007
    UMD 2010
    I think knowing ceftriaxone for gonnorrhea + 1 dose azithro (or a course of doxy) for chlamydia is important. I must have been asked this 20 times. Ditto on bactrim for UTI (despite UWs crazy made up UTI drugs...)
  8. GynGuy1983

    GynGuy1983 C&A Psychiatry Fellow 7+ Year Member

    Jun 13, 2008
    Rathke's pouch

    They're all about that one dose treatment plan for gonnorrhea and chlamydia so you don't have the patient come back to your clinic still complaining of dysuria a week later.
  9. opb

    opb 7+ Year Member

    Jun 6, 2008
    I'm in agreement with this... it's important to treat for both gonorrhea and chlamydia (cephalosporin and azithromycin) even if you don't test for both. Also, syphillis gets penicillin. As for UTIs, I usually just pick TMP/SMX unless contraindicated due to allergy. Good luck!
  10. Instatewaiter

    Instatewaiter But... there's a troponin 10+ Year Member

    Apr 28, 2006
    I agree with what everyone else said- gon/chlam= cephalosporin+ azith/doxy
    UTI- bactrim of ciprofloxacin
    Syphilis- penicillin

    And a random note: if you have a pregnant woman who has syphillis and an allergy to penicillin you still give penicillin.
  11. TerpMD

    TerpMD 2+ Year Member

    Sep 26, 2007
    UMD 2010
  12. ShyRem

    ShyRem I need more coffee. Physician Moderator Emeritus 10+ Year Member

    Jun 17, 2004
    Where I hang my hat.
    how about nitrofurantoin for UTI in a pg patient?
  13. GynGuy1983

    GynGuy1983 C&A Psychiatry Fellow 7+ Year Member

    Jun 13, 2008
    Rathke's pouch
    Yeah, it's fine, it falls in the Class B pregnancy category. TMP-SMX is CONTRAINDICATED in women that are preggers though.
  14. osli

    osli Senior Member 5+ Year Member

    Oct 13, 2005
    Agree with above, but as mentioned don't forget about nitrofurantoin. Hardly ever mentioned, but it concentrates in urine and has activity pretty much only there and nowhere else, and does a great job against most bladder infections. Major toxicity is to the lung, so the patient has to be aware of early symptomatology. Gonorrhea/syphilis/chlamydia gets the usual. Amoxicillin for chlamydia in pregnancy instead of azithromycin.

    Syphilis really needs penicillin, and if necessary you can do a one-time desensitization process in the case of allergy, even in pregnancy. It's not something to be taken lightly though, and shouldn't be stopped once you start.

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