AANP Family Nurse Practitioner (FNP) Certification ExamEvaluationEasy
A 70-year-old female presents with a 3-day history of dysuria, urinary frequency, and suprapubic pain. She denies fever, flank pain, or vaginal discharge. Urinalysis shows positive leukocyte esterase, nitrites, and numerous bacteria. She has no known drug allergies. Which of the following is the most appropriate initial treatment?
- ANitrofurantoin 100 mg twice daily for 5-7 days.
- BCiprofloxacin 250 mg twice daily for 3 days.
- CTrimethoprim-sulfamethoxazole (TMP-SMX) DS twice daily for 3 days.
- DAmoxicillin 500 mg three times daily for 7 days.
Show answer & explanationAnswer & explanation
Correct answer: C. Trimethoprim-sulfamethoxazole (TMP-SMX) DS twice daily for 3 days.
This patient presents with uncomplicated cystitis. Given her age, TMP-SMX DS for 3 days is a first-line recommended treatment for uncomplicated UTIs in areas with low resistance rates, and it's generally effective and well-tolerated.
Why the other options are wrong
- A. Nitrofurantoin is another first-line option, but typically given for 5-7 days for uncomplicated cystitis, and may be less effective for pyelonephritis (though not indicated here). It's also less preferred in elderly patients with creatinine clearance <30-60 mL/min.
- B. Fluoroquinolones like ciprofloxacin are generally reserved for complicated UTIs or when first-line agents are not appropriate due to resistance concerns and potential for adverse effects.
- D. Amoxicillin is not recommended as first-line empirical therapy for UTIs due to high rates of resistance.
Uncomplicated UTI Management
Uncomplicated urinary tract infections (UTIs) in non-pregnant, healthy women are typically treated with short courses (3-5 days) of specific antibiotics, considering local resistance patterns.
- Symptoms include dysuria, frequency, urgency, suprapubic pain.
- Absence of fever, flank pain, systemic illness indicates uncomplicated UTI.
- First-line agents include nitrofurantoin, TMP-SMX, and fosfomycin.
Memory trick: For a simple UTI, choose 'T-N-F': Trimethoprim, Nitrofurantoin, or Fosfomycin!