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antibiotic guideline

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Hi everyone, I am NP student and wonder if anyone could help me with antibiotics guideline in reality. My story is that I shadowed my preceptor, who works at the clinic, and one of our patients who presented with increasing frequency of urination, dysuria, and microhematuria in urine via urine dip. My preceptor diagnosed her as cystitis. My preceptor prescribed Keflex 500mg twice a day. I asked the etiology of prescribing Keflex instead of Nitrofurantoin per CDC or uptodate recommendation, but I could not understand well what she was trying to explain to me. Does anyone could light my mind up? Thank you

Silverdragon102, BSN

Specializes in Medical and general practice now LTC. Has 33 years experience.

Moved to the NP forum

Numenor, BSN, MSN, NP

Specializes in Internal Medicine. Has 9 years experience.

On 6/2/2020 at 2:12 PM, vuphan86 said:

Hi everyone, I am NP student and wonder if anyone could help me with antibiotics guideline in reality. My story is that I shadowed my preceptor, who works at the clinic, and one of our patients who presented with increasing frequency of urination, dysuria, and microhematuria in urine via urine dip. My preceptor diagnosed her as cystitis. My preceptor prescribed Keflex 500mg twice a day. I asked the etiology of prescribing Keflex instead of Nitrofurantoin per CDC or uptodate recommendation, but I could not understand well what she was trying to explain to me. Does anyone could light my mind up? Thank you

I work inpatient so I use our biogram with most of our UTIs warranting IV/stronger antibiotics so 3rd + gen cephalosporins or fluoroquinolones are my go to drugs (although I try to avoid them...). It comes down to resistance rates in your area for the most common causes of UTIs. Maybe there kidney or allergy issues. Macrobid is usually a good first choice, so maybe this patient has a history of more frequent UTIs or there are resistance issues?

Like I said, I work inpatient but cephalexin would not be my first choice regardless. I don't think she is wrong though and it will probably get the job done.

Edited by Numenor

LovingPeds, MSN, APRN, NP

Specializes in Clinical Pediatrics; Maternal-Child Educator. Has 11 years experience.

I work outpatient peds. We treat our UTIs with weight/age based Keflex. Adolescents are treated with Keflex or Bactrim. Anyone with a combination UTI/sinusitis type situation is prescribed Augmentin. The rationale being that we have low rates of E. coli resistance and Keflex has fewer serious side effects than Macrobid. It also has been more extensively studied and used in children so there is a level of comfort prescribing there. These antibiotics have been successful for us in clearing UTIs in our population with most children asymptomatic at follow-up.

Edited by LovingPeds

Numenor, BSN, MSN, NP

Specializes in Internal Medicine. Has 9 years experience.

40 minutes ago, LovingPeds said:

I work outpatient peds. We treat our UTIs with weight/age based Keflex. Adolescents are treated with Keflex or Bactrim. Anyone with a combination UTI/sinusitis type situation is prescribed Augmentin. The rationale being that we have low rates of E. coli resistance and Keflex has fewer serious side effects than Macrobid. It also has been more extensively studied and used in children so there is a level of comfort prescribing there. These antibiotics have been successful for us in clearing UTIs in our population with most children asymptomatic at follow-up.

Interesting, definitely different for the adult world! Bactrim is sometimes used (probably second to Macrobid) but its interactions and transient increase in Cr (debatable) makes it less common

LovingPeds, MSN, APRN, NP

Specializes in Clinical Pediatrics; Maternal-Child Educator. Has 11 years experience.

12 minutes ago, Numenor said:

Interesting, definitely different for the adult world! Bactrim is sometimes used (probably second to Macrobid) but its interactions and transient increase in Cr (debatable) makes it less common

Yes. Different world all together. Macrobid suspension is really expensive ($400+ for less than 240 mL) and not well tolerated. You have to sprinkle capsules in food if you go that route which can make exact dosing difficult. There are a surprising number of teenagers who can't swallow pills too. Fortunately you see more variety in the recommendations for us than you do in the adult population.

On 6/3/2020 at 2:49 PM, Numenor said:

I work inpatient so I use our biogram with most of our UTIs warranting IV/stronger antibiotics so 3rd + gen cephalosporins or fluoroquinolones are my go to drugs (although I try to avoid them...). It comes down to resistance rates in your area for the most common causes of UTIs. Maybe there kidney or allergy issues. Macrobid is usually a good first choice, so maybe this patient has a history of more frequent UTIs or there are resistance issues?

Like I said, I work inpatient but cephalexin would not be my first choice regardless. I don't think she is wrong though and it will probably get the job done.

Thank you for all your feedback. I'm appreciated. I agree with you, Numenor. I asked one of our inpatient physician. he told me that hospital provides physician the link called antibiogram for antibiotic. In this antibiogram, it will tell physicians what antibiotics treat what bacteria and it also depend on the communities I will work with. From there, I could prescribe the antibiotics.

aok7, NP

Has 12 years experience.

I found board prep books helpful about antibiotics. I think Leik book was excellent. Of course, truly understanding the pharmacology of antibiotics requires simply memorizing, but to apply to clinical care it does help to practice mock prescribing and know why you would do one over other. For example fluoroquinolones, what it the QT interval consideration, and only after researching the basics after two or three patients will your mind go to considering cardiac status and other meds, etc. I also use the antibiogram, but clinically just seeing a bunch of patients and their overall situation (in reality or case scenarios) will give you confidence.