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

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.