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Ampicillin
21%
4/19
Ceftriaxone
16%
3/19
Ciprofloxacin
0%
0/19
Doxycycline
5%
1/19
Nitrofurantoin
53%
10/19
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This patient is presenting with dysuria suggesting a diagnosis of a urinary tract infection (UTI). The most appropriate treatment for this pregnant patient is nitrofurantoin. Urinary tract infections (UTIs) are common during pregnancy as physiologic changes including ureteral dilation and urinary stasis can increase the risk of a UTI. The most common causative organism is Escherichia coli. All pregnant women should be screened during prenatal visits for bacteriuria and treated appropriately. In pregnancy, asymptomatic bacteriuria can result in cystitis or ascend to pyelonephritis. The treatment of a simple cystitis in pregnancy can include agents such as nitrofurantoin (avoided in the first trimester), cefpodoxime, amoxicillin-clavulanate, and fosfomycin. Incorrect Answers: Answers 1-2: Ampicillin and ceftriaxone are possible agents that could be given to a patient with a complicated UTI or pyelonephritis; however, it is unnecessary for a simple UTI as keeping this patient in the hospital for IV antibiotics would likely cause more harm. Answer 3: Ciprofloxacin can cause tendon rupture and is contraindicated in pregnancy. It would only be indicated for a complicated UTI in a nonpregnant patient. Answer 4: Doxycycline is contraindicated in pregnancy and would be an agent typically used for skin infections such as an abscess with surrounding cellulitis. Bullet Summary: A UTI in pregnancy can be treated with nitrofurantoin, cefpodoxime, amoxicillin-clavulanate, and fosfomycin.
4.8
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