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A 33-Year-Old Woman, Gravida 3 Para 2, at 31 Weeks

question 48

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A 33-year-old woman, gravida 3 para 2, at 31 weeks gestation comes to the emergency department due to fever, nausea, vomiting, and right flank pain.  The patient has no chronic medical conditions and her pregnancy has been uncomplicated.  She is admitted to the hospital for acute pyelonephritis and started on intravenous ceftriaxone.  Forty-eight hours later, the patient feels better and has become afebrile.  She is able to eat a normal diet and has had no nausea or vomiting for the past day.  Current temperature is 36.7 C (98.1 F) , blood pressure is 110/70 mm Hg, and pulse is 76/min.  Fetal heart tones are 130/min.  The abdomen is nontender and there is no costovertebral angle tenderness.  Urine culture from the day of hospital admission grows Escherichia coli with the following sensitivities: A 33-year-old woman, gravida 3 para 2, at 31 weeks gestation comes to the emergency department due to fever, nausea, vomiting, and right flank pain.  The patient has no chronic medical conditions and her pregnancy has been uncomplicated.  She is admitted to the hospital for acute pyelonephritis and started on intravenous ceftriaxone.  Forty-eight hours later, the patient feels better and has become afebrile.  She is able to eat a normal diet and has had no nausea or vomiting for the past day.  Current temperature is 36.7 C (98.1 F) , blood pressure is 110/70 mm Hg, and pulse is 76/min.  Fetal heart tones are 130/min.  The abdomen is nontender and there is no costovertebral angle tenderness.  Urine culture from the day of hospital admission grows Escherichia coli with the following sensitivities:   Which of the following is the most appropriate oral antibiotic therapy for this patient at this time? A) Cephalexin B) Ciprofloxacin C) Nitrofurantoin D) No additional antibiotic therapy indicated E) Trimethoprim-sulfamethoxazole Which of the following is the most appropriate oral antibiotic therapy for this patient at this time?


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A financial state where the cash inflows in a business exceed the outflows, indicating financial health.

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