Welcome to the #MEDIGRAM Patient Case: Chief Compliant Series. Short, concise patient cases to foster thought-provoking questions and to challenge you to ask questions! Make sure to by at the end of the week for explanations for the correct/incorrect answers.
📑 Patient Case CC: Dysuria, Hx ESBL E. coli UTI - #MEDIGRAM
👹 42yoF (sulfa-anaphylaxis) presents with painful urination. Reports Hx of ESBL E. coli UTI (no records), currently on prednisone for an acute gout attack. Dx: Cystitis Which antibiotic should we give to empirically cover for ESBL E. coli?
Our options are cephalexin, levofloxacin, nitrofurantoin, and sulfamethoxazole-trimethoprim. By definition, ESBL bugs are resistant to extended spectrum cephalosporins and we can't use cephalexin. She has a history of anaphylaxis to sulfa; if you selected D you shouldn't be taking care of patients. We could use levofloxacin, but there is a better option with the risk of tendon rupture in the setting of acute prednisone use. The safest and best choice empirically will be nitrofurantoin as it can cover ESBL pathogens and is great for uncomplicated UTIs.
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