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Urinary Tract Infection (UTI): Antibiotic Treatment (Nursing)

by Rhonda Lawes

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    00:00 Now, remember, this is a whole team sport.

    00:03 Healthcare providers, lab, nurses, pharmacists were all involved in the process, and the effort it takes to get effective treatment.

    00:11 We're all looking at that sensitivity table.

    00:13 We want to find one antibiotic that will take out both organisms.

    00:18 So I'm looking for one antibiotic that marked as susceptible or sensitive to that drug.

    00:26 Alright, and you're ready to take it to the next level.

    00:28 Let's take a look at these results again.

    00:30 And I want you to think through them like a real practicing nurse.

    00:34 I want you to see if you can identify the options for effective treatment based on the sensitivity table for both organisms.

    00:42 First of all, I want you to start by crossing out the drugs we would absolutely not give.

    00:49 Now pay attention to the letters, not the numbers.

    00:52 Remember, the numbers just represent the MIC.

    00:55 So it doesn't mean if you see one drug, they're both effective, and one is at eight and one is at 16.

    01:01 It doesn't mean the 16 is better.

    01:03 So ignore the numbers.

    01:05 Just take a look at the letters R and S.

    01:09 So go ahead take a look at your chart like a practicing nurse would and cross through the medications that we would not use to treat both of these organisms.

    01:20 Okay, good deal. Did you get that? Ampicillin is resistant for organism one.

    01:26 It's sensitive to organism two.

    01:28 But you should draw a line through ampicillin because we wouldn't give it because it doesn't treat both organisms.

    01:34 The other one is tetracycline.

    01:36 You'll see that it's sensitive for organism one, but it's resistant for organism two, just the opposite of ampicillin.

    01:43 But you want to draw a line through that one.

    01:47 Now that you found those, I want you to look for medications that will treat both of the organisms.

    01:53 Circle those drug names.

    01:59 Okay, good deal.

    02:00 I hope you found those over on the right.

    02:02 Levofloxacin and Nitrofurantoin.

    02:05 Okay, so you found the medications because look at both columns, In levofloxacin, we've got an S for sensitivity for microorganism one, and S for sensitive for organism two.

    02:17 Same thing with nitrofurantoin S for sensitivity, and organism one and S for sensitivity to organism two.

    02:26 Alright, so let's compare these.

    02:28 If you get a culture and sensitivity report back, looking at this sensitivity table we have more than one medication to pick from.

    02:35 So let's use the same criteria we used in the other example.

    02:39 Let's look at efficacy.

    02:41 Well, we've got both options that were work and we know they're both going to have good efficacy.

    02:46 Because we looked at that information on the sensitivity table.

    02:50 And you can also consult other clinical resources.

    02:53 You can look at UpToDate, or Epocrates, or First Consult.

    02:57 These are programs that are available to healthcare practitioners to follow up and help you make an informed decision.

    03:03 Now keep in mind levofloxacin, is a fluoroquinolone.

    03:07 And that could be used, but we usually keep fluoroquinolone for more serious types of infections, rather than acute cystitis, which is just a bladder infection.

    03:17 So unless there's some known or suspected resistance, that's not likely going to be the one that we're going to choose.

    03:24 But let's keep walking through it. Let's look at cost.

    03:27 Well, levofloxacin is going to be $18 for seven days.

    03:30 We're giving roughly 750 milligrams.

    03:33 It's going to be almost twice that for the other medication.

    03:37 What about risk for adverse effects? There is a slight risk of tendon rupture with levofloxacin.

    03:44 But remember, if it's nitrofurantoin, we want to avoid that in the elderly, because their kidneys are not going to be working with us enough to keep a therapeutic level in the serum, or the blood.

    03:55 Resistance can be per patient history, and drug availability.

    04:00 Both drugs are available.

    04:02 So in this case, really the biggest adverse effect we found was that we try to reserve levofloxacin for other types of more serious infections.

    04:12 So we would likely go with nitrofurantoin unless the patient was elderly.


    About the Lecture

    The lecture Urinary Tract Infection (UTI): Antibiotic Treatment (Nursing) by Rhonda Lawes is from the course Interpretation of Renal Lab Values (Nursing).


    Included Quiz Questions

    1. Treat with one antibiotic for which all organisms are susceptible
    2. Treat with as many antibiotics as necessary
    3. Treat with the most cost-effective antibiotic
    4. Treat with the antibiotic with the lowest risk of side effects
    1. Nurses
    2. Pharmacists
    3. Laboratory professionals
    4. Nursing assistants
    5. Respiratory therapists

    Author of lecture Urinary Tract Infection (UTI): Antibiotic Treatment (Nursing)

     Rhonda Lawes

    Rhonda Lawes


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