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Add ciprofloxacin to antibiotic regimen
9%
2/22
Add penicillin to antibiotic regimen
5%
1/22
Perform a renal ultrasound
Send a urine culture
45%
10/22
Test for gonorrhea and chlamydia
23%
5/22
Select Answer to see Preferred Response
This pregnant patient is suffering from acute cystitis and is appropriately treated with nitrofurantoin. In pregnant patients, if urinalysis is found to be positive, urine culture should be sent in addition to initiating antibiotics. Urine culture is necessary in order to assess the sensitivity of the infecting organism to the prescribed antibiotics. This allows for antibiotic therapy to be adjusted to the most effective agent. Due to the physiologic changes associated with pregnancy (including urinary retention, ureteral dilation, and increased urinary tract volume), pregnant patients are at an increased risk of acquiring and developing severe complications from urinary tract infections. In pregnant patients, pyelonephritis requires hospital admission and intravenous antibiotic treatment. However, asymptomatic bacteriuria and cystitis may be managed with oral antibiotic therapy. It is important to note that asymptomatic bacteriuria must be treated in a pregnant patient in contrast to other populations. Incorrect Answers: Answer 1: Add ciprofloxacin to antibiotic regimen is inappropriate as it can lead to tendon rupture and is contraindicated in pregnancy. It could be used to treat a complicated urinary tract infection; however, it is not a preferred initial agent in most patients. Answer 2: Add penicillin to antibiotic regimen is unnecessary and is not appropriate for treating a UTI. There is widespread resistance to penicillin; therefore, addition of this medication would not be beneficial regardless. Answer 3: Perform a renal ultrasound is the diagnostic test of choice in a pregnant patient with a kidney stone which would present with flank pain that radiates to the groin with hematuria. An ultrasound spares the pregnant mother from being exposed to radiation and may demonstrate hydronephrosis. Answer 5: Test for gonorrhea and chlamydia would likely be performed at this patient's early prenatal appointments; however, there is no need to repeat testing in this patient merely because she is presenting with a UTI. Bullet Summary: Management of a UTI in pregnancy involves urinalysis, administration of antibiotics, and sending off a urine culture.
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