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A 45-year-old female presents to emergency room complaining of urinary frequency, burning during urination, and weakness. Her last menstrual period was one year ago, and she is not sexually active. She is not taking any medications. Her temperature is 37.8 C (100 F), blood pressure is 120/76 mmHg, pulse is 80/min, and respirations are 14/min. Very mild costovertebral angle tenderness is present. IV ceftriaxone is started. Two days later, the patient feels much better. Antibiotic susceptibility testing returned with an uropathogen (E.coli) highly sensitive to ceftriaxone, gentamycin, ciprofloxacin and trimethoprim/sulfamethoxazole (TMP/SMX). Which of the following is the most reasonable next step in the management of this patient?
A. Add ciprofloxacin to the regimen
B. Switch to TMP/SMX
C. Switch to gentamycin
D. Continue ceftriaxone
E. Discontinue antibiotic therapy
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BBB switch to a lower antibiotic when susceptible.we started empiric antibiotic therapy when we felt it was acute pyelonephritis.now she is better, so no harm in switching over.
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ans bbb
This patient has signs and symptoms suggestive of uncomplicated pyelonephritis. It seems that the condition responded to parenteral antibiotic therapy. The patients with uncomplicated pyelonephritis can be usually switched to an oral antibiotic after 48-72 hours of parenteral therapy (Choice D). At this point, the most reasonable step is to switch to an oral antibiotic chosen according to the antibiotic susceptibility testing. TMP/SMX is a good choice, because it is relatively cheap. The average duration of antibiotic therapy during uncomplicated pyelonephritis is two weeks (Choice E). There is no reason to add another antibiotic (Choice A) or switch to another parenteral agent (Choice C).
Educational Objective:
After 48-72 hours of parenteral therapy for uncomplicated pyelonephritis, the patient can be usually switched to an oral agent. Oral therapy is more convenient and less expensive; if the results of antibiotic susceptibility testing are known, the appropriate antibiotic can be easily chosen.
*Extremely high yield question for USMLE!!!
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thanks highsky, is it UW qs?
