A 56-Year-Old Man Comes to the Physician with Fever, Chills

question 313

Multiple Choice

A 56-year-old man comes to the physician with fever, chills, and painful urination for 3 days.  He has also experienced decreased force in his urinary stream, urinary frequency, and nocturia.  The patient was diagnosed with benign prostatic hyperplasia 2 years ago.  His other medical problems include hypertension, hyperlipidemia, and type 2 diabetes mellitus.  His medications include saw palmetto, metformin, enalapril, and lovastatin.  He is sexually active with his wife of 35 years.
His temperature is 38.3° C (101° F) , blood pressure is 127/84 mm Hg, and pulse is 98/min.  There is no costovertebral angle tenderness bilaterally.  His genitalia and testes are normal.  His prostate is enlarged and very tender to palpation on digital rectal examination.
Laboratory results are as follows:

Urine and blood cultures are sent.  Urine Gram stain shows no organisms.
Which of the following would be the best next step in management of this patient?

• A)Foley catheter insertion
• B)Oral doxycycline
• C)Oral levofloxacin
• D)Prostatic massage for fluid
• E)Transrectal ultrasound