malinda
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A 20-year-old female presents with a two day history of dysuria and increased urinary frequency. She states that
she was recently married and was not sexually active prior to the marriage. Physical exam reveals a temperature
of 100.7 °F with normal vital signs. Gynecological exam reveals no evidence of discharge, vaginitis, or cervicitis.
Urinalysis reveals 14 white blood cells per high-powered field with many gram-negative rods. The most
appropriate therapy would be
A. ampicillin
B. ceftriaxone
C. fluconazole
D. gentamicin
E. metronidazole
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| msyamp
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ampicilin
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| robin082006
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agree,
and choose quinolone if it's given in the ans
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| malinda
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it is simple UTI.Is quinolone drug of choice for simple UTIs and what is drug of choice for complicated UTI s plz?
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| msyamp
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it iss called honeymoon cystitis. most cmmon cause is e coli
but also staph in 10% CASES.
complicated and simple?
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| malinda
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yES.the treatment options for simple UTI and complicated UTI are different .isnt it?
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| Doc2378
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for recurrent/ complicated UTIs its TMP-SMX...I think.. correct me if I am wrong guys
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| bactitech
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Ampicillin may have been the first choice some years ago, but many E. coli are now resistant to amp. TMP-SMX or Nitrofurantoin are much better choices than ampicillin nowadays. How old is your reference?
This is an excellent article in Medscape and is from 2003 (you can register for free if you cannot read it - I highly recommend this website):
http://www.medscape.com/viewarticle/460756_6
"The current IDSA treatment guidelines for AUC [acute uncomplicated cystitis] recommend a 3-day regimen of TMP/SMX. This agent has been in use for AUC for more than 20 years and has been highly effective. The IDSA guidelines, however, also suggest that in areas where the prevalence of resistant pathogens is 10% to 20% or higher, alternatives should be considered for empiric therapy. In most parts of the United States, the 10% resistance threshold of E coli to TMP/SMX has been crossed, and, in some areas, the prevalence of resistance is 20%. For other agents, such as amoxicillin, the prevalence is 20% to 30%, and this agent is no longer recommended as empiric therapy for UTI.[28,33,34]"
The article also has a table that states that out of 122,519 isolates of EC, the percent resistant to ampicillin was nearly 40%. TMP/SMX for 123,691 isolates was 19% amp resistant, and Nitrofurantoin for 105,000 isolates was only 1% resistant. Cipro was 4% resistant for 107,000 isolates. Cipro is LOTS more expensive than Nitro or TMP/SMX. We see ampicillin resistance in EC routinely in the laboratory I work in (we do the work for four hospitals, outpatients, and nursing homes).
Please see entire article for LOTS more interesting information. The days where ampicillin was the drug of choice have long since gone.
Edited by bactitech on 01/17/06 - 09:10 PM
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