A 38 year old woman presents with dysuria and fever...

A 38-year-old female presents complaining of urgency, frequency, and dysuria. She is found to have a temperature of 38°C (102 F), no flank pain, and a urinalysis positive for nitrites and leukocyte esterase. 

Which of the following is the most appropriate treatment regimen?

A. Trimethoprim-sulfamethoxazole DS bid for 3 days
B. Norfloxacin 400 mg PO bid for 7 to 14 days
C. Ciprofloxacin 250 mg PO bid for 5 days
D. Trimethoprim 300 mg PO every day for 3 to 5 days
E. Amoxicillin 500 mg PO bid for 10 days

Answer : B. Norfloxacin 400 mg PO bid for 7 to 14 days

Discussion: The first thing to realize is that this does not meet the requirements for an uncomplicated cystitis (UTI). The patient has a fever of 102°F and thus by definition needs to be treated as an uncomplicated pyelonephritis. Due to the high rates of resistance to amoxicillin, it is no longer a recommended treatment. There is also increasing resistance to sulfonamides and trimethoprim sulfamethoxazole. The recommended initial oral agent for uncomplicated pyelonephritis (prior to knowing the resistance pattern) is a fluoroquinalone (usually ciprofloxacin, levo-floxacin). For the uncomplicated UTI you can choose between a short course therapy of 3 days and the longer therapy of 7 days. Older patients and women with recurrent history of UTIs need the longer regimen. Although the duration of treatment for a complicated UTI is controversial, most experts would favor a course of at least 7 to 14 days