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 NBME did u find answer to this Q  



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Author8 Posts
  #1

. A 19-year-old primigravid woman at 34 weeks' gestation comes to the physician for a routine prenatal visit. Her pregnancy has been uncomplicated. She has no history of serious illness. She takes no medications and has no known allergies. Examination shows a uterus consistent in size with a 34-week gestation. A routine clean-catch urine culture grows greater than 100,000 colonies/mL of Escherichia coli. Which of the following is the most appropriate pharmacotherapy?

A
) Ampicillin

B
) Ciprofloxacin

C
) Clindamycin

D
) Doxycycline

E
) Trimethoprim-sulfamethoxazole

NOTE u canot give ampicillin empirically as E coli is resistant to it





  #2

B, D are contraindicated in Preg, E. is contraindicated in near term Preg. Clindamycine (C) has less effective to E.coli.

The most appropriate Ans is A. Choice A is a recommendation in CDMT

Nitrofurantoin is the best choice, but it is not here


  #3

A

Antibiotics can use in this case: Penicillin, Ampicillin, Nitrofurantoin, and first generation cephalosporin (Kaplan)


  #4

A) Ampicillin




  #5

but also in kapaln q bank said that , you canot give ampicillin empirically coz e coli increasingly resistant to it


  #6

E is contraindicated near term (after 36 )weeks maybe


  #7

Dr Jojo..DO NOT confuse urself,and follow what kaplan notes and UW on this if u want to score high in USMLE..the best drugs for UTI during the third trimester is either ampicillin and cephalosporin...Put the pt on ampicillin and if her fever doesnt decrease,say within 24 hrs,then switch to broader spectrum antibio like cephalosporins,not that you assume rt from the beginning that the pt is resistant to the MC drugs used in UTI during pregnancy..
NONE of the above drugs given in the choices are given during pregnancy, and TMP-SMX coz kernictrus in the new born if used in third trimester...Most probably they wont give u both ampi and ceph in the choices, iit will be one of them..and the answer here is defintly A----period

GL


  #8

I agree the best response is A





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