A 24-year-old woman presents to the outpatient clinic with a 2-day history of burning with urination and increased urinary frequency. She reports no fever, chills, back pain, or vaginal discharge. She is sexually active with one male partner and uses condoms inconsistently. Her last menstrual period was 2 weeks ago. Vital signs are temperature 37.0°C (98.6°F), blood pressure 110/70 mmHg, pulse 78/min, and respirations 14/min. Physical examination reveals mild suprapubic tenderness but no costovertebral angle tenderness. A urine pregnancy test is negative. Urinalysis is positive for leukocyte esterase and nitrites. Which of the following is the most appropriate pharmacotherapy for this patient?
- AOral ciprofloxacin
- BOral azithromycin
- CIntravenous ceftriaxone
- Oral nitrofurantoinCevap
- EOral amoxicillin-clavulanate
Cevap
Oral nitrofurantoin
This patient presents with classic signs and symptoms of uncomplicated acute cystitis: dysuria, frequency, and suprapubic tenderness, without systemic signs of infection (e.g., fever) or upper tract involvement (e.g., flank pain). Her positive urinalysis confirms the diagnosis. The most appropriate next step is to prescribe targeted, first-line empiric oral antibiotic therapy. Nitrofurantoin is a preferred first-line agent because it is highly concentrated in the urine, has excellent activity against Escherichia coli (the most common uropathogen), and has a narrow spectrum of activity, which aligns perfectly with proper antibiotic stewardship.
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First-line empiric therapy for uncomplicated acute cystitis should utilize narrow-spectrum agents such as nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin to adhere to antibiotic stewardship principles.