Avelox for UTI??

[Sparda29]

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On Saturday I received a prescription for Levaquin 500 mg QD X 10 Days. Naturally, NYS Medicaid doesn't cover Levaquin without a prior authorization. I didn't feel like going to the process and delaying the treatment so I called the doctor's office... it's closed but he left his cell phone # on the voicemail.

I call him up and he tells me to give the guy Avelox. It's a male patient and it's a UTI, so it would be a complicated UTI infection, and I've been told that Avelox has poor penetration into the kidney and urinary tract. I'm going...

I didn't wanna get into a fight with the doctor so I just told him that Avelox was out of stock. He seemed to be in a rush to get me off the phone so he just told me to pick whatever I wanted to treat the UTI.

I decided to go with Ciprofloxacin 500 mg BID X 14 Days. Did I do the right thing?

 

[All4MyDaughter]

What did your pharmacist say?

 

[Sparda29]

What did your pharmacist say?

She was fine with it. Then again, ID isn't her favorite topic.

 

[evilolive]

That's ridiculous when the MD says pick whatever you want. Is real life really like that? I laughed when I saw that he picked moxifloxacin for a UTI...

 

[Sparda29]

That's ridiculous when the MD says pick whatever you want. Is real life really like that? I laughed when I saw that he picked moxifloxacin for a UTI...

IMO, that's the ideal practice of pharmacy. Physician tells you the diagnosis, you pick the therapy.

 

[npage148]

Please don't start another Avelox UTI debated. It's be rehashed more times than I care to think about. It work's fine, search the forums

 

[J ROD]

I would have done cipro for 10 days.....

 

[evilolive]

Please don't start another Avelox UTI debated. It's be rehashed more times than I care to think about. It work's fine, search the forums

Weird, I was just going by what my attending said on rounds (and what I remember seeing in my notes). I wasn't aware there was a controversy.

 

[avuong]

how about macrodantin?

Under what circumstances would one choose cipro/levofloxacin/moxifloxacin over nitrofurantoin (or any other antibiotic indicated for UTI) for treating UTI?
Thank you

 

[Praziquantel86]

how about macrodantin?

Under what circumstances would one choose cipro/levofloxacin/moxifloxacin over nitrofurantoin (or any other antibiotic indicated for UTI) for treating UTI?
Thank you

It's supposed to go by regional susceptibility patterns. Bactrim and nitrofurantoin are generally first line, but some areas have pretty high rates of resistance. They move on to Cipro once resistance gets high enough.

That being said, a lot of docs completely ignore that and head straight to Cipro.

 

[Quiksilver]

It's supposed to go by regional susceptibility patterns. Bactrim and nitrofurantoin are generally first line, but some areas have pretty high rates of resistance. They move on to Cipro once resistance gets high enough.

That being said, a lot of docs completely ignore that and head straight to Cipro.

I guess I won't be drinking the water when i go to Long island 😀

 

[J ROD]

It's supposed to go by regional susceptibility patterns. Bactrim and nitrofurantoin are generally first line, but some areas have pretty high rates of resistance. They move on to Cipro once resistance gets high enough.

That being said, a lot of docs completely ignore that and head straight to Cipro.

yeah, we were told that macrobid was pretty much useless and should not be used alone.

 

[njac]

yeah, we were told that macrobid was pretty much useless and should not be used alone.

and I see the opposite in our antibiogram. Our cipro and bactim susceptibilities to e.coli are in the pooper.

 

[Sparda29]

It's supposed to go by regional susceptibility patterns. Bactrim and nitrofurantoin are generally first line, but some areas have pretty high rates of resistance. They move on to Cipro once resistance gets high enough.

That being said, a lot of docs completely ignore that and head straight to Cipro.

This guy actually had a history of UTIs, he's been treated for this many times before. I'm assuming that either he's really susceptible to infection or the infections are not going away. 😕

 

[J ROD]

and I see the opposite in our antibiogram. Our cipro and bactim susceptibilities to e.coli are in the pooper.

be safe and just give them everything....shotgun approach!!

 

[J ROD]

OR, the first yr medical resident answer:


Vanc and Zosyn!!

I swear every answer was this!!

The attending told them they could not say that anymore for the rest of the week and they were begging for answers.

No Pseudo....try Unasyn

Not everyone has MRSA!! 🙄

 

[Glycerin]

Yeah, the moxi for UTI and penetration has been discussed at length already on the forums.

 

[museabuse]

Please don't start another Avelox UTI debated. It's be rehashed more times than I care to think about. It work's fine, search the forums

What is with everyone complaining about using the search function everytime someone brings up something that was discussed previously? Why can't you ignore it if it bothers you. Maybe someone will have something new and interesting to say. Maybe you should be a moderator and just delete every post that has been discussed before. You might have 1 or 2 new posts a week. That would be an awesome forum! seriously get a life, and quit bitching about minor things.

 

[Farmercyst]

Our ID lecturer says to reserve quinolones as last line for pretty much anything. Although, in her hospital she's lost about 30% psuedomonas coverage due to resistance, so I can kind of understand. Local C&S should decide. For our final today, I guarantee that this would not be given a quinolone unless everything else were ruled out. Looks like SMx/TMP or Macrobid are first line, Keflex or Aminopenicillin/BLase combo 2nd line, Quin 3rd. Probably go 10-14 days for male.

 

[Sparda29]

What is with everyone complaining about using the search function everytime someone brings up something that was discussed previously? Why can't you ignore it if it bothers you. Maybe someone will have something new and interesting to say. Maybe you should be a moderator and just delete every post that has been discussed before. You might have 1 or 2 new posts a week. That would be an awesome forum! seriously get a life, and quit bitching about minor things.

Couldn't find a thread that happened within the last 2 months with this title.

 

[npage148]

http://forums.studentdoctor.net/search.php?searchid=12629941


http://forums.studentdoctor.net/showthread.php?t=430532&highlight=AVELOX+UTI

http://forums.studentdoctor.net/showthread.php?t=576506&highlight=AVELOX+UTI

2 multipage threads about Avelox and UTI.

 

[Sparda29]

http://forums.studentdoctor.net/search.php?searchid=12629941


http://forums.studentdoctor.net/showthread.php?t=430532&highlight=AVELOX+UTI

http://forums.studentdoctor.net/showthread.php?t=576506&highlight=AVELOX+UTI

2 multipage threads about Avelox and UTI.

Right, one of the threads was started in 2007 and called Quinolones in UTI, that one didn't show up since I filtered my search to posts from 2009 alone.

Other thread was called ID Question, which I wouldn't have looked at since the title didn't match what I was looking for. If I don't see what I want in the title, I'm going to start a new thread.

 

[StaviZFingerZ]

DiPepeptidyl Peptidase 4 also known as the CD 26 is a T cell stimulator in which when inhibited, can affect the immune response of T-cell, B-Cell, and Natural Killer Cells. Obviously this can trigger an increase in infection coupled with GLP inhibition which results in inflammation and allergy like symptoms.

But some studies suggest the immune activating component of DPP-4 is not affected by DPP4 inhibitor..

Oh yeah? Then how come Trovafloxacin with 6%-9% renal clearance was used for UTI while we can't use Moxi with 20% renal clearance?

Are you saying Moxi's renal concentration isn't high enough to treat simple UTI with E. Coli? What say you resident?

Wow... these 2 guys are brilliant!! Whatever happened to these 2???

 

[njac]

What about that Epic douche?

 

[StaviZFingerZ]

What about that Epic douche?

Yeah!! I think he got banned for trolling! 👍

 

[Rebel78]

Had a medical resident write Macrobid four times a day last week. I didn't say much because they're learning, first year. But I said "there's a reason it's called macroBID" 😀

 

[Farmercyst]

This guy actually had a history of UTIs, he's been treated for this many times before. I'm assuming that either he's really susceptible to infection or the infections are not going away. 😕

Sounds like a better Hx should be taken to figure out what he's used in the past (resistance) and why so many (hygiene, DM, etc)

 

[smileyangel11]

My general rule for treating UTI is that:

If drug does not need to be renally adjusted, it typically should not be used for UTI (unless you have concurrent bacteremia).

Hence, Cipro for UTI, Moxi NOT. Same principle follows such as Fluconazole for fungal UTI, Voriconazole NOT, etc.

My understanding is that renal fractional excretion (Fe) has to be high enough for an UTI treating drug, hence, they often are dose reduced in renal insufficiency.

 

[njac]

My general rule for treating UTI is that:

If drug does not need to be renally adjusted, it typically should not be used for UTI (unless you have concurrent bacteremia).

Hence, Cipro for UTI, Moxi NOT. Same principle follows such as Fluconazole for fungal UTI, Voriconazole NOT, etc.

My understanding is that renal fractional excretion (Fe) has to be high enough for an UTI treating drug, hence, they often are dose reduced in renal insufficiency.

While I mostly agree with this principle - what about Ceftriaxone for UTI?

Where I am now it is really a workhorse for UTIs with pretty good results. I think we have better Ceftriaxone susceptibility with e.coli than the FQs

 

[Praziquantel86]

My general rule for treating UTI is that:

If drug does not need to be renally adjusted, it typically should not be used for UTI (unless you have concurrent bacteremia).

Hence, Cipro for UTI, Moxi NOT. Same principle follows such as Fluconazole for fungal UTI, Voriconazole NOT, etc.

My understanding is that renal fractional excretion (Fe) has to be high enough for an UTI treating drug, hence, they often are dose reduced in renal insufficiency.

What do you use for VRE UTI (assuming ampicillin-resistant)?

 

[smileyangel11]

While I mostly agree with this principle - what about Ceftriaxone for UTI?

Where I am now it is really a workhorse for UTIs with pretty good results. I think we have better Ceftriaxone susceptibility with e.coli than the FQs

NJAC- excellent point! That's just a general principle when I consider 1st line choices for UTI. Rocephin definitely works, I do use it in some patients w/ complicated UTI.

Another important issue to consider for antibiotic efficacy is plasma/tissue penetration ratio. My argument for Rocephin is that it has excellent penetration. Thus, you achieve efficacy given low renal Fe. By the same token, some people claims that Moxifloxacin works for UTI based on experience. I believe it is probably real, but I never recommend it, since I was never forced into a case where it is the only choice.

Someone asked a question on VRE UTI. In a simple UTI (presume your antibiogram allows and Unasyn is resistant), you can consider Macrobid. If complicated or systemic, use Linezolid. It is another drug with low Fe, but it also has fairly good penetration, so you do get efficacious result.

 

[Praziquantel86]

NJAC- excellent point! That's just a general principle when I consider 1st line choices for UTI. Rocephin definitely works, I do use it in some patients w/ complicated UTI.

Another important issue to consider for antibiotic efficacy is plasma/tissue penetration ratio. My argument for Rocephin is that it has excellent penetration. Thus, you achieve efficacy given low renal Fe. By the same token, some people claims that Moxifloxacin works for UTI based on experience. I believe it is probably real, but I never recommend it, since I was never forced into a case where it is the only choice.

Someone asked a question on VRE UTI. In a simple UTI (presume your antibiogram allows and Unasyn is resistant), you can consider Macrobid. If complicated or systemic, use Linezolid. It is another drug with low Fe, but it also has fairly good penetration, so you do get efficacious result.

I like the penetration argument...I think that makes more sense for complicated infections than simple renal elimination.

I was expecting you would say daptomycin for the VRE question. Given the penetration explanation, linezolid does make sense.