Question 16

Question:

A 32-year-old female is admitted to the hospital after complaining of urinary frequency, dysuria, and weakness. She is not sexually active and LMP was one week ago. She is afebrile, her blood pressure is 118/80, and her pulse is 68/min. Costovertebral angle tenderness is elicited. IV ceftriaxone is started. Three days later, the patient is afebrile and feels much better. Antibiotic susceptibility testing showed E. coli highly sensitive to ceftriaxone, gentamicin, ciprofloxacin, and trimethoprim/sulfamethoxazole (TMP/SMX). Which is the best next step in the management of this patient?

Correct Answer: E.  Switch to oral TMP/SMX

This patient has signs and symptoms suggestive of uncomplicated pyelonephritis, which responded appropriately to parenteral antibiotic therapy. Patients with uncomplicated pyelonephritis can usually be switched to an oral antibiotic after about 72 hours of parenteral therapy. The most reasonable step would be to switch to an oral antibiotic according to the susceptibility testing.