Ivonne
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A 62 yo M c/o dysuria, frequency and urgency for four days. He feels slightly feverish and has had dull lower back pain for the past few months. He has had several episodes of dysuria for the last several months. Each time he was given an antibiotic for one week and the symptoms resolved. Currently his temperature is 100.7 F. The genital examination is unremarkable and the digital rectal examination reveals a non-tender prostate, which is normal in size and consistency, with no palpable masses. After gentle massage of the prostate, a small amount of purulent discharge is extruded from the urethral meatus. The urine culture grows 100 000 colonies/ml of E coli. Urine culture of his prior episode also grew E coli but 10 000 colonies/ml. Which of the following is most appropriate:
a. cystoscopy
b. Ciprofloxacin and azytromycin orally once now
c. trimethopin/sulfamethoxazol for 1 week
d. Renal ultrasound
e. Ciprofloxacin for 4 to 6 weeks
Explain your answer pz
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| GOGETA
I'm Dr. GOGETA
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step1 DX=fever back pain and disuria= pyelonephritis
Step2 the guy is old but no signs of BPH
I go with A
because you need to see what is going on.
And acourse then you go with E that is treatment
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| sandra
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a or d?
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| hero
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Do not instrument infected bladder, you can trigger septic shock.
(Pestana)
Looks like chronic prostatitis, probably e is the answer.
(he was given antibiotics for 1 wk, it didn't work, only choice longer is E, renal ultrasound will not show prostate)
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| Ivonne
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This patient has chronic bacterial prostatitis that can present with lower abdominal pain, perineal pain or low back pain. On PE the prostate feels normal and is non tender. As in this patient chronic prostatitis can present as a recurrent urinary tract infection. The key to the diagnosis is culture of the urine or urethral discharge. E coli is a very common cause. Most antibiotics don't have a good penetration into the prostate and it takes at least 4 weeks of therapy with ciprofloxacin to clear the infection.
Thanks all
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| mildus
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thanks
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