| A |
cool doctor, toofar, ansalshah |
3 |
18% |
| B |
aspire, drdadi, dr.wad, solitarius, nyimalay |
5 |
29% |
| C |
peter90036, Justice, vijay1900 |
3 |
18% |
| D |
doc649, drafzalscotty |
2 |
12% |
| E |
fd, foucesed doc, lq2006, dr19 |
4 |
24% |
| Author | 7 Posts |
Justice
Forum Fanatic
Topics: 100
Posts: 1,878
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Please vote with your answer
A 49-year-old woman has had four urinary tract infections in the past 7 months. She was referred to a urologist, who found no abnormalities during cystoscopy. The patient refused further work-up.
Which of the following is the most appropriate management strategy to prevent recurrent urinary tract infections in this patient?
A. Long-term low-dose amoxicillin, 250mg orally daily
B. Long-term full-dose trimethoprim/sulfamethoxazole, 160/800 mg orally twice daily
0. Patient-initiated 3-day course of ciprofloxacin, 250 mg orally twice daily
D. Use of spermicides
E. Prompt urination after sexual intercourse
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| DrVirgo
Forum Hero
Topics: 1041
Posts: 3,342
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Recurrent UTIs -She needs to be on prophylactic antibiotics.
Which ones? hhmm...
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| guangyu
Forum Elite
Topics: 29
Posts: 308
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E
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| aspire
Forum Senior
Topics: 24
Posts: 158
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Recurrent cystitis-
related to coitus- high dose TMP+SMX
unrelated to coitus-low doseTMP+SMX
Within 2 weeks of treatment if infection occurs with the original infecting organism--> look for urologic abnormalities.
Am I right? Or is it Cipro? 
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| Justice
Forum Fanatic
Topics: 100
Posts: 1,878
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The correct answer is C
Antimicrobial agents can be useful in preventing recurrences of urinary tract infections. Many drugs have been tested, and the best outcomes are associated with trimethoprim/sulfamethoxazole, nitrofurantoin, and fluoroquinolones. A patient-initiated fluoroquinolone given for several days is effective in the early treatment of urinary tract infections. Most women are able to distinguish urinary tract infections from other illnesses with a high degree of accuracy. This is a cost-effective treatment that has the least effect on bacterial ecology.
The use of β -lactams is disappointing for prophylaxis because gastrointestinal flora can be quickly altered so that β -lactam-resistant organisms proliferate. This, in turn, can cause recurrent urinary tract infections even during periods of treatment or prophylaxis. Use of trimethoprim/sulfamethoxazole for prophylaxis may be of concern because the number of strains of uropathogens resistant to this agent has been gradually increasing. Furthermore, the dose for prophylaxis should be lower than the full therapeutic dose in order to minimize the risk of side effects that are somewhat dose- and duration-dependent. Spermicides increase the risk of urinary tract infections. Therefore, patients with recurrent infections should be advised to use some other form of contraception. Factors such as sexual positioning, post-coital voiding, and post-toileting habits have not been shown to correlate with the risk of developing acute or recurrent urinary tract infections
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| dr19
Forum Senior
Topics: 10
Posts: 109
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treatment of recurrent infections according to Step-up:
"low-dose prophylactic antibiotics,e.g.,low-dose TMP/SMX,for 6 months
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| dr19
Forum Senior
Topics: 10
Posts: 109
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