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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Recognize the common signs and symptoms of acute uncomplicated cystitis/urinary tract infections (UTI) in females.

  • Design a therapeutic regimen for the treatment of acute uncomplicated cystitis after consideration of symptoms, medical history, allergies, objective findings, and desired clinical response.

  • Describe parameters that should be monitored during the treatment of acute uncomplicated cystitis to ensure efficacy and minimize toxicity.

  • Provide patient education on the proper administration of antibiotic therapy for acute uncomplicated cystitis including directions for use, the administration of therapy in relation to meals, the importance of medication adherence (including the need to complete the entire prescribed course), proper storage, and potential side effects of the medication.

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PATIENT PRESENTATION

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Chief Complaint

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“It burns when I urinate. I am urinating all the time.”

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HPI

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Sarah Ramsey is a 26-year-old woman who presents to a family practice clinic in Seattle with complaints of dysuria, urinary frequency and urgency, and suprapubic tenderness for the past 2 days.

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PMH

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Patient has been diagnosed with three UTIs over the past 8 months based on symptoms, each treated with oral TMP–SMX

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FH

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Mother has DM; remainder of FH is noncontributory

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SH

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Denies smoking but admits to occasional marijuana use and social EtOH use. Patient has been sexually active with one partner for the past 9 months and typically uses spermicide-coated condoms for contraception.

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Meds

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None

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All

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No known allergies

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ROS

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Patient reports urethral pain and burning with urination, as well as mild suprapubic tenderness. Patient denies systemic symptoms such as fever, chills, vomiting, or back pain, and does not report any urethral or vaginal discharge. Upon further questioning, the patient notes that the UTIs started soon after she met her boyfriend, and she does not always completely empty her bladder after sexual intercourse.

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Physical Examination

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Gen
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Cooperative woman in no acute distress

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VS
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BP 110/60, P 68, RR 16, T 36.8°C; Wt 57 kg, Ht 5′5″

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Skin
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No skin lesions

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HEENT
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PERRLA; EOMI; TMs intact

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Neck/Lymph Nodes
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Supple without lymphadenopathy

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Chest
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CTA

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CV
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RRR, no MRG

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Back
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No CVA tenderness

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Abd
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Soft; (+) bowel sounds; no organomegaly or tenderness

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Pelvic
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