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LEARNING OBJECTIVES

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

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

  • Design a therapeutic regimen for the treatment of acute uncomplicated cystitis after consideration of symptoms, medical history, allergies, objective findings, drug–drug interactions, 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, administration of therapy in relation to meals, importance of medication adherence (including the need to complete the entire prescribed course), proper storage, and potential side effects of the medication.

PATIENT PRESENTATION

Chief Complaint

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

HPI

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

PMH

Patient has been previously diagnosed with three UTIs over the past 8 months based on symptoms. Each episode was treated with oral TMP/SMX.

FH

Mother has DM; remainder of FH is noncontributory.

SH

Denies smoking but admits to occasional marijuana 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.

Meds

None

All

No known allergies

ROS

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

Physical Examination

Gen

Cooperative woman in no acute distress

VS

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

Skin

No skin lesions

HEENT

PERRLA; EOMI; TMs intact

Neck/Lymph Nodes

Supple without lymphadenopathy

Chest

CTA

CV

RRR, no MRG

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