1 infec 82 - tabish60102

[ArchivalUser]

A 27-year-old woman has a 1-day history of dysuria, left flank pain, and fever. The patient is sexually active. She had one episode of cystitis 3 months ago that was treated successfully with trimethoprim-sulfamethoxazole. Urine cultures were not obtained at that time.

On physical examination, the patient appears uncomfortable but not acutely ill. Temperature is 38.5 °C (101.3 °F), pulse rate is 100/min, respiration rate is 18/min, and blood pressure is 120/78 mm Hg. There is pain on percussion of the left flank.

The leukocyte count is 20,000/μL (20 × 109/L) with 80% segmented neutrophils and 5% band forms. Urinalysis shows a leukocyte count of 100/hpf and a positive test for leukocyte esterase.

Which of the following is the most appropriate empiric therapy for this patient?

A Oral trimethoprim“sulfamethoxazole
B Intravenous trimethoprim“sulfamethoxazole
] C Oral amoxicillin“clavulanate
D Oral levofloxacin
[ E Intravenous levofloxacin

[ArchivalUser]

aa

[ArchivalUser]

aa

[ArchivalUser]

what is the diagnosis? Pyelonephritis?

[ArchivalUser]

ddd

[ArchivalUser]

D)

[ArchivalUser]

(Correct Answer = D)
Key Point
Oral levofloxacin rather than intravenous levofloxacin is indicated for empiric treatment of a highly compliant patient with acute pyelonephritis who can eat and drink.

This patient has pyelonephritis, and the most important first step is to determine the route of therapy. In general, oral therapy is used only for a highly compliant patient who can eat and drink, and the parenteral route is used for a patient who is nauseated or vomiting. A parenteral regimen can be changed to oral therapy once the patient has been stabilized and can tolerate oral drugs.

Oral therapy is suitable for the patient described here, and levofloxacin for 7 to 14 days is the most appropriate of the regimens listed. Until recently, a 14-day course of levofloxacin was the standard of care. There is good evidence, however, that a 7-day course is sufficient for patients with uncomplicated acute pyelonephritis.

Because of increasing resistance to trimethoprim“sulfamethoxazole, this drug should not be used for empiric treatment of acute pyelonephritis. The following classes of antimicrobial agents may be considered for empiric therapy for this disorder: fluoroquinolones, third-generation or extended-spectrum cephalosporins, extended-spectrum penicillins or aminoglycosides, monobactams, and carbapenems. Although oral β-lactams such as amoxicillin“clavulanate are sometimes effective, published studies to date show that they are inferior to levofloxacin.
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