WBR1056

Author	[[PageAuthor::Abdurahman Khalil, M.D. [1]]]
Exam Type	ExamType::USMLE Step 2 CK
Main Category
Sub Category	SubCategory::Genitourinary, SubCategory::Infectious Disease
Prompt	[[Prompt::A 32 year old woman G1P1 comes to the clinic complaining of urgency, frequency and burning during urination for the last 4 days. She never had this problem before. She denies any fever, night sweating or pain. Her past medical history unremarkable except for caesarian section 3 years ago. She doesn’t smoke, drinks alcohol occasionally and sexually active with her husband, her vitals are Temperature: 37, 1 , heart rate: 78 , respiration: 17, blood pressure: 134/67. The physical examination is normal except for mild tenderness over the pubic area. Tapping on Costco vertebral angel doesn’t show any tenderness. No vaginal discharge. What’s the preferred treatment for this patient?]]
Answer A	AnswerA::Nitrofurantoin
Answer A Explanation	AnswerAExp::Correct, nitrofurantoin is the preferred antibacterial to treat acute cystitis.
Answer B	AnswerB::Ciprofloxacin
Answer B Explanation	AnswerBExp::Incorrect. Broad spectrum antibiotics are reserved for intolerance or failure of first line antibacterials.
Answer C	AnswerC::Ceftriaxone
Answer C Explanation	AnswerCExp::Incorrect. Beta-lactams is not recommended because of the increasing resistance, in addition to their adverse effects and poor efficacy.
Answer D	AnswerD::Doxycycline
Answer D Explanation	AnswerDExp::Incorrect. Doxycycline is used to treat chlamydiae, but is not as effective to treat e.coli which is the most common cause of simple cystitis.
Answer E	AnswerE::Erythromycin
Answer E Explanation	AnswerEExp::Incorrect. not effective to treat acute cystitis.
Right Answer	RightAnswer::A
Explanation	[[Explanation::The clinical presentation is typical for acute uncomplicated cystitis, e.coli is the most common cause of this infection, and empiric treatment initiated with out urine culture unless it is complicated infection or during pregnancy. Educational Objective: *Acute uncomplicated cystitis definition includes Premenopausal, nonpregnant women with no known urological abnormalities or comorbidities,postmenopausal women or well-controlled diabetic female patients. The decision to use antimicrobials should be case baesd, in other words it should depend on the patients specifics like allergy and compliance history, availability and cost of treatment and resistant rates at the local community. Being the most common cause of cystitis (75-90%), E.Coli susceptibility should be considered to choose the appropriate empirical antimicrobial. Other organisms like Proteus mirabilis, Klebsiella pneumoniae and Staphylococcus saprophyticus are less common. Nitrofurantoin, fosfomycin and mecillinam are prefered as first line treatment because have less resistance among other antibacterials with similar efficacy. References: IDSA guidelines for acute cystitis.]]
Approved	Approved::No
Keyword	WBRKeyword::Cystitis, WBRKeyword::E.coli, WBRKeyword::Antibiotic resistance
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::