Objectives:

• Evaluate a patient with urinary symptoms
• Treat uncomplicated UTI
• Identify risk factors for complicated UTI
• Manage a patient with pyelonephritis

A 23-year-old female presents to your office complaining of a urinary tract infection. For the last 3 days, she has experienced burning with urination, increased frequency of urination, and urgency to urinate. She denies vaginal discharge, fevers, chills, nausea, and flank pain. She reports, “I tried to beat it with cranberry juice, but I guess I need antibiotics.” Her exam, including vital signs, is normal. Urinalysis shows 2+ leukocyte esterase, 2+ blood, 50 WBCs/hpf, 10 RBCs/hpf, and many bacteria (squamous cells are rare).

1		Your next action is to:
			A)	Culture her urine.
			B)	Start an antibiotic.
			C)	Prescribe a bladder anesthetic.
			D)	Obtain a CBC.
			E)	Recommend drinking twice as much cranberry juice.
2		All of the following are acceptable first-line agents in a woman with an uncomplicated urinary tract infection EXCEPT:
			A)	Nitrofurantoin.
			B)	Ciprofloxacin.
			C)	An oral cephalosporin (e.g., cephalexin (Keflex))
			D)	Trimethoprim/sulfamethoxazole.
			E)	Azithromycin.

When a patient develops a urinary tract infection, it is frequently cystitis or an uncomplicated UTI.

3		All of the following are risk factors for complicated UTI or renal infection EXCEPT:
			A)	Advancing age.
			B)	Frequent sexual intercourse.
			C)	Diabetes.
			D)	Recent antibiotic use.
			E)	Tampon use.
4		If you suspected that your patient had acute pyelonephritis, which of the following antibiotic regimens would you choose?
			A)	Trimethoprim/sulfamethoxazole DS PO BID for 3 days.
			B)	Trimethoprim/sulfamethoxazole DS PO BID for 10 days.
			C)	Levofloxacin 500 mg PO QD for 7 days.
			D)	Ceftriaxone 1 g IV QD for 7 days.