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Observation and treatment if symptoms develop
3%
2/58
Nitrofurantoin for seven days
90%
52/58
Observation and repeat cultures in one week
2%
1/58
Nitrofurantoin for duration of pregnancy
Levofloxacin for three days
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This young pregnant woman has asymptomatic bacteriuria. It should be treated with antibiotics at an appropriate dose and frequency (nitrofurantoin for seven days) to prevent progression to pyelonephritis. Asymptomatic bacteriuria is classified by a significant presence of bacterial colonies in the urine (> 100,000 cfu) in an asymptomatic patient. Close to five percent of all pregnant woman are affected by asymptomatic bacteriuria, which can progress to pyelonephritis in pregnant women due to urinary stasis and ureteral dilation (right more than left). Thus, it must be treated. A variety of oral drugs can be used to treat the pregnant patient, including amoxicillin-clavulanate for three to seven days, fosfomycin (one dose), cephalosporins, and nitrofurantoin for seven days. Trimethoprim-sulfamethoxazole can be used but is avoided during the first trimester. Incorrect Answers: Answers 1-3: Observation and treating for symptoms or repeating cultures will delay necessary antibiotics and increase the risk of prenatal complications. Repeating urine cultures will be necessary after an appropriate antibiotic course. Answer 4: Nitrofurantoin for the entire duration of pregnancy is unnecessary. It could increase the risk for development of multidrug-resistant bacteria. Answer 5: Levofloxacin is a fluoroquinolone which is contraindicated in pregnant patients due to the potential of irreversible bone and joint injury in the developing fetus. Bullet Summary: Asymptomatic bacteriuria of pregnancy should be treated with appropriate antibiotics (amoxicillin-clavulanate, fosfomycin, cephalosporins, and nitrofurantoin) to minimize risk of pyelonephritis and preterm labor.
3.7
(6)
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