A 25-year-old, generally healthy woman comes to the office with burning on urination. There are 50 white cells on the urinalysis.
What is the next best step in management?
a. Wait for results of urine culture.
b. Obtain urine culture.
c. Treat with TMP/SMX for 3 days.
d. Treat with ciprofloxacin for 7 days.
e. Perform a renal ultrasound.
Answer:
c. Treat with TMP/SMX for 3 days.
Discussion: When there are clear symptoms of cystitis and white cells in the urine, it is not necessary to obtain a urine culture or to wait for results of either the culture or a sonogram. For uncomplicated cystitis, go straight to treatment for 3 days.
Ultrasound is important in male patients, as it is unusual for a male patient to have a urinary tract
infection in the absence of an anatomic abnormality.
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