Urgent Care For UTI 3 — Questions and Answers
Question 1: A 72-year-old woman with recurrent UTIs asks about prevention strategies. Which of the following has the best evidence for reducing recurrent UTIs in postmenopausal women?
- Daily oral vitamin C supplementation
- Topical vaginal estrogen (Correct answer)
- Prophylactic oral fluconazole
- Daily cranberry extract capsules
Correct answer: Topical vaginal estrogen
Topical vaginal estrogen restores normal vaginal flora and has strong evidence for reducing recurrent UTIs in postmenopausal women.
Question 2: A male patient aged 45 presents with dysuria and frequency. Prostate exam is normal. What is the recommended duration of antibiotic therapy for uncomplicated cystitis in men?
- 3-day course same as women
- 5-day course of nitrofurantoin
- 7-day course of fluoroquinolone or TMP-SMX (Correct answer)
- 14-day course due to risk of prostatitis
Correct answer: 7-day course of fluoroquinolone or TMP-SMX
Men with cystitis are treated for 7 days because short-course therapy has higher failure rates in males due to anatomical and prostatic factors.
Question 3: Which urinalysis finding is the MOST specific for a true UTI versus contamination?
- Positive leukocyte esterase
- Positive nitrites (Correct answer)
- Presence of squamous epithelial cells
- Cloudy urine appearance
Correct answer: Positive nitrites
Positive nitrites are highly specific for gram-negative bacteriuria because they indicate bacterial reduction of dietary nitrates.
Question 4: A hospitalized patient develops a fever and new costovertebral angle tenderness 5 days after admission. UA grows gram-negative rods. Which empiric antibiotic choice is most appropriate for hospital-acquired pyelonephritis?
- Nitrofurantoin PO
- Ceftriaxone IV
- Piperacillin-tazobactam IV (Correct answer)
- Fosfomycin PO
Correct answer: Piperacillin-tazobactam IV
Hospital-acquired infections carry higher risk for resistant organisms including ESBL-producing and Pseudomonas species, warranting broader coverage with piperacillin-tazobactam.
Question 5: A 26-year-old woman presents with her third UTI in 6 months. Cultures have consistently grown E. coli sensitive to all agents. What is the most appropriate preventive strategy?
- Long-term daily suppressive antibiotics with nitrofurantoin 50 mg (Correct answer)
- Prophylactic daily fluconazole
- Urology referral for cystoscopy immediately
- Repeat urine culture monthly regardless of symptoms
Correct answer: Long-term daily suppressive antibiotics with nitrofurantoin 50 mg
Low-dose continuous antibiotic prophylaxis with nitrofurantoin 50 mg nightly is evidence-based for women with recurrent UTIs (≥3/year).
Question 6: Fosfomycin trometamol is used for uncomplicated cystitis. What is the standard dosing regimen?
- 3 g orally once as a single dose (Correct answer)
- 100 mg orally twice daily for 5 days
- 400 mg orally three times daily for 3 days
- 500 mg orally once daily for 7 days
Correct answer: 3 g orally once as a single dose
Fosfomycin 3 g as a single oral dose is the approved regimen for uncomplicated cystitis and is useful for ESBL-producing organisms.
Question 7: A urine culture from a patient with recurrent UTIs grows Proteus mirabilis. Which complication is Proteus uniquely associated with?
- Renal abscess formation
- Urease production leading to struvite kidney stones (Correct answer)
- Urosepsis with DIC
- Rapidly progressive glomerulonephritis
Correct answer: Urease production leading to struvite kidney stones
Proteus mirabilis produces urease, which splits urea into ammonia, alkalinizing the urine and promoting struvite (magnesium ammonium phosphate) stone formation.
Urgent Care For UTI 3
A 72-year-old woman with recurrent UTIs asks about prevention strategies.
Which of the following has the best evidence for reducing recurrent UTIs in postmenopausal women?