Question

A 24-year-old female presents to the walk-in clinic with complaints of increased urinary urgency and a burning sensation during urination, for the past three days. The patient relates that she has had a urinary tract infection in the past, about age 15, but denies any other problems with her urinary tract since then. She tells you that she recently began a new job as a second-grade teacher in the public school system, which required her to go three to four hours at a time without the opportunity to go to the bathroom, and this was new to her. She has been drinking cranberry juice, which she heard was helpful for UTIs, but it does not seem to have helped alleviate the symptoms. Other than seasonal allergies, which she treats with diphenhydramine, she has no significant medical history. She is a healthy well-nourished adult female. Takes no medications and her only reported drug allergy is to penicillin severe allergic reaction when she was a child). Physical exam findings are as follows: • Vital signs: Temperature 101.3°F, blood pressure 121/79, pulse 74, respirations 15. • Weight: 135 lbs, height 64 inches • Eyes and Ears: Appear normal. • Neck & Lymph Nodes: Thyroid gland symmetrical, no nodules or lymphadenopathy • Chest: Clear to auscultation. • Heart: Regular rate: S, and S2 heart sounds present. • Lungs: Clear to auscultation bilaterally anterior and posterior. • Abdomen: Nontender, no organomegaly. • Genitourinary: Normal external genitalia; no vaginal discharge. • Rectal: No hemorrhoids. • Labs: Blood work: Normal; Urine analysis, results are pending, although specimen collected looked yellow and cloudy in the specimen container. Urine culture: culture positive for Gram-negative rods (E.coli). and sensitivities show: Amoxicillin - S Ciprofloxacinus Ceftriaxone=S • TMP-SMX-R

Answer 1

1.Microscopic analysis include presence of causative organism in urine, presence of wbc or hematuria for uti.

2.ciprofloxacin 500 mg per oral once in a day for 3 days is recommended for uncomplicated uti. Drug should be taken after 2 hours of food item rich in calcium , antacids and proton pump inhibitors as they interfere with absorption of drug.

3. amoxicillin not prescribed as she is having penicillin allergy

As causative organism is resistant to TMP so not chosen.

ciprofloxacin is chosen over ceftriaxone as it is recommended as first line drug in uncomplicated uti.
patient education:

• take medicine regularly.
• dont double dose if dose is missed.
• avoid taking medicine with calcium rich food like dairy products, antacids etc
• Discontinue and report any symptoms of tendinitis, bleeding occurs.