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Peds ID Abx QOTW #22 Answer

a) Treat with nitrofurantoin for 5d for simple cystitis

b) Treat with Bactrim for 3d for simple cystits

c) Screen for STIs

d) Treat empirically for GC/chlamydia

e) Give Rx to patient for partner treatment

• This patient has simple cystitis with no complicating factors (we are assuming she is not pregnant as that information is not given in the case description)
• First-line antibiotic therapies for simple cystitis include:
– Nitrofurantoin for 5 days
– TMP-SMX for 3 days
– Fosfomycin one dose
– Pivmecillinam for 5-7 days
• Some would say that this patient’s recent antibiotic treatment might place her at increased risk of resistance, in which case TMP-SMX would not be a good choice
• Fluoroquinolones and beta-lactam agents (including cephalexin) are considered second-line options
• Given this patient’s prior history of STI with inadequate post-treatment abstinence from sex and  follow-up, she should be re-screened for STIs
– Currently, there is a high prevalence of gonorrhea, chlamydia, and syphilis, and empiric treatment + partner therapy to reduce re-infection is warranted as well
• Reference: Uptodate