Reference no: EM133299705
Question 1
A 48-year-old woman is diagnosed with her 3rd incidence of uncomplicated cystitis in the last 18 months. The trimethoprim-sulfamethoxazole resistance rate for E. coli is 15% in the community. Her last prescription filled was TMP/SMX and was completed 10 days ago.
What would be the best choice treatment of an uncomplicated UTI for this patient?
Mini-Case 2 Question 2
A 50-year-old woman is admitted to the ICU with severe pyelonephritis. She has a history of anaphylaxis with penicillin. Fluoroquinolone resistance is 5%. Bactrim resistance is 10%.
What would be the most appropriate empiric treatment?
Mini-Case Question 3
A 45-year-old woman is suspected to be developing renal disease, so a urinalysis is completed. It is discovered that she has Presence of 1 or more species of bacteria in the urine, greater than 105 CFU/mL without accompanying symptoms of infection.
What would you recommend for this patient?
Mini-Case Question 4
A 77-year-old female presents to the ER with her daughter who states her mother has had an altered mental status. She is concerned that she is very confused and forgetful for the past 3 days. She also notes a change in eating habits and nausea. A urinalysis reveals a urinary tract infection.
Which of the following treatments may exacerbate confusion in this patient?
A. Amoxicillin
B. Ciprofloxacin
C. Bactrim
D. Macrobid
Full Patient Case
Patient Case
Setting: Ambulatory Care Clinic Insurance: Harvard Pilgrim Chief complaint: It hurts to pee.
History of present illness: Thirty-two-year-old white woman visits her ambulatory care clinic because she recently developed pain upon urination within the past 2 days. She noticed this developed after having sex with her husband. She has been taking Azo Urinary Relief over the counter and cranberry supplements for the past day.
Past medical history: GERD, hypothyroidism
Social history: Drinks 4 oz of wine about once per week. Nonsmoker
Family history: Mother and father still living with no significant comorbidities. No siblings and no children
Review of systems: Integumentary: No color changes; no itching or rash found. Eyes: No vision changes; no blurriness or dryness. ENT: No sore throat, no canker sores, and no sinusitis. Respiratory: No dyspnea, cough, infection, purulent sputum production, or shortness of breath. Musculoskeletal: No pain or weakness or any cramps or joint pain. Genitourinary: Noted pain with urination, increased frequency, and suprapubic pain. No hematuria or flank pain. Gastrointestinal: No nausea or vomiting. Psychiatric: No depression, anxiety, or hallucinations
Medication history: Levothyroxine 75 mcg once daily, omeprazole 20 mg twice daily Allergies: No known drug allergies
Adverse drug reactions: N/A
Current prescription medications: Levothyroxine, omeprazole
Current nonprescription medications: Phenazopyridine (Azo Urinary Relief), cranberry supplement, multivitamin, calcium carbonate as needed
Current complementary and alternative medications: N/A
Past prescription medications: Levothyroxine, omeprazole
Past nonprescription medications: Multivitamin, calcium carbonate as needed Past complementary and alternative medications: N/A
Adherence: Adherent
Immunization history: Up to date
Physical exam: Alert and oriented ×3
Vital signs: BP 124/76, HR 60 bpm, RR 18 breaths per minute. Temperature 99.6°F. Oxygen saturation at 100% on room air
Height: 5' 4". Weight: 125 lb
HEENT: PERRLA, EOMI
Chest and lungs: Normal breath sounds
Cardiovascular: RRR, not significant for murmurs or gallops. Normal S1 and S2 Abdominal: Soft, tender, and no distention and no guarding
Neurologic: Reflexes are intact.
Extremities: No cyanosis, no clubbing, and no edema
Labs and diagnostic tests: Hcg (-), UA: leukocyte esterase positive, >105bacteria/mL. Local antibiogram shows 77% susceptibility of E coli to Bactrim.