What would the most appropriate therapy be? A 20-year-old female presents with a two-day history of dysuria and increased urinary frequency. She states that she was recently married and was not sexually active prior to the marriage. Physical exam reveals a temperature of 100.7 Â°F with normal vital signs. Gynecological exam reveals no evidence of discharge, vaginitis, or cervicitis. Urinalysis reveals 14 white blood cells per high-powered field with many gram-negative rods.
A. Ampicillin B. Ceftriaxone C. Fluconazole D. Gentamicin E. Metronidazole
Ampicillin-the correct answer is a. the patients presentation is consistent with a simple urinary tract infection; there is a short history of dysuria, increased urinary frequency and the appearance of white blood cells and gram-negative rods in the urine. urinary tract infections are common in women after they become sexually active. the infection is likely caused by urethral trauma during intercourse, which leads to bacterial contamination of the bladder. since the majority of these infections are caused by escherichia coli (a gram-negative rod), the most appropriate therapy would be ampicillin for around 10 days. ceftriaxone (choice b) is the treatment of choice for uncomplicated infections with n. gonorrhoeae, now that most strains are resistant to penicillin. intravenous ceftriaxone is a regimen reserved for the treatment of life-threatening infections. fluconazole (choice c) is indicated for the treatment of vaginal candidiasis. since there is no vaginal discharge and the patient has gram-negative rods in the urine, a diagnosis of vaginal candidiasis can be excluded.
gentamicin (choice d) would be an inappropriate choice since the majority of urinary tract infections caused by gram negative rods are sensitive to ampicillin and the potential for toxicity secondary to gentamicin is great. metronidazole (choice e) is an antibiotic typically used in the treatment of trichomoniasis, giardiasis, and gardnerella, as well as serious infections believed to be caused by anaerobic bacteria. since there is no vaginal discharge and the patient has gram negative rods in the urine, one can conclude that these infections
are not present and the patient instead has a urinary tract infection.