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Location:Office

Presentingcomplaint: 25 YO WH F presents with burning micturition.

Vitalsulse:80/min,B.P:130/80mmHg, Temp:990F, R.R:14/min,Height:67
inches(167.5cm), Weight:79Kg(173.8lbs).

HPI:A25-year-oldpersonal secretaryatalocal officepresentswiththecomplaints
of threedaysof burningmicturition, urgency, andfrequency.
Shehadtopassurine 10timesyesterday.
Shealsocomplainsof suprapubicdiscomfort.
Thereisno vaginal discharge, fever, hematuria, orflankpain.
Shehasnoprevioushistoryof STDorUTI.

ROSisunremarkable. Shehasnoknownallergies.

Medications:None.

SH:Sheisapersonal secretaryatalocal office. Shehasbeenmarriedforfiveyears
andhasnochildren. Shehasbeensmoking10cigarettesforthelastsevenyears
anddrinksalcohol onweekends.Sheissexuallyactiveinamonogamousrelation
withherhusband.Theyhavenotbeenpracticingcontraception.Herlastmenstrual
periodwas3weeksago.

Howdoyouapproachthiscase?

what will u order in
1. examination
2. tests
3. treatment review based on d/d
4. counselling

d/d: dysuria in a young female
acutepyelonephritis,
acutecystitis,
acutepelvicinflammatorydisease,
acuteurethritis, or
acutecervicitis.

focussed exam:
abdominal
pelvic

orders:
UA , stat
Pregnancy test: no contraception, LMP 3 weeks, abx use likely

what antibiotics(abx) to use if pregnant or if nonpregnant?

If pregnant use azithromycin , non pregnant use trimethoprim sulphamethoxazole or ampicillin

Assuming diagnosis is :

Uncomplicated acute cystitis and Pregnancy

7-dayamoxicillin;
if the patient is also allergic to penicillin“7-day nitrofurantoin
also for preg pt:

1.Follow-upforprenatal assessment
2.Prenatal vitamin, oral, continuous
3.Considercounselingaboutthefollowing:
- Smoking cessation
- Limitalcohol
- Regularexercise
- Useof seatbelt
- Medicationcompliance


If pt is non pregnant and for other similar presentatio in different pt categories:
Treatment of uncomplicated cystitis:
-Normal healthywomen : a3 dayTMP-SMZ
and for:
-Diabeticwomen,
-symptomsfor>7days,
-recurrentUTI,>65yrsagegroup
a 7 day TMP-SMZ