Question

A 27-year old female presents to the emergency department with a 4-day history of fever, chills, and bilateral CVA (costovertebral angle) pain. She reports having at least 12 previous episodes. She has been seeing the same family practitioner since birth and was diagnosed as having “nervous bladder and kidney syndrome.” On physical examination, patient is flushed with a temperature of 102.2F and has intermittent shaking rigors. CVA tenderness is present bilaterally on palpation. Her abdomen is tender to palpate with guarding but no rebound. Patient’s urine appears to be cloudy and urine dip reveals large (4+) leukocytes with (3+) nitrates. Following a urinalysis and a urine specimen for culture and sensitive, you should now provide which of the following treatments to this patient?

A. Ciprofloxacin (cipro) 500 mg twice a day for 3 days

B. Begin acetaminophen and fluid hydration

C. Trimethoprim-Sulfamethoxazole (bactrim) twice a day for 7 days

D. Begin IV antibiotics and admit patient to hospital

Answer 1

The patient has CVA pain ,this could be because of certain renal infection .The fever with chills of 102.2 F is a clear indicator of strong infection .The patient will need antibiotics and admission to reduce fever and pain due to infection

Ciprofloxacin for just three days will not be effective

Barring is the line of treatment

Acetaminophen can only treat fever and pain but the root cause of infection will not be treated which can again cause fever

Ans:Begin IV antibiotics and admit patient to hospital