Acute Pyelonephritis
Young F with h/o sexual intercourse with new male partner, recurrent UTIs, DM presents with urinary frequency/urgency, dysuria, N/V. Pt's mother has h/o recurrent UTIs. T>38 C, CVA tenderness, suprabupic pain on exam.
U/A showing +LE, microscopic pyuria/hematuria; reflex for culture
Obtain BMP; consider ordering lipase, transaminase, beta-hCG
[Pregnent: Admit to hospital and start CTX; transition to oral antibiotics x 10 days once afebrile. Suppressive therapy with daily low-dose nitrofurantoin s/p treatment course.]
Negative urine pregnancy test; start levofloxacin 750 mg BID x 5 days
Re-evaluate pt within 48-72hr
Consider CT if pt's symptoms fail to improve or if symptoms recur s/p initial treatment
Consider hospitalization if pt develops hemodynamic instability, metabolic derangement, severe flank/abdominal pain, toxic appearance, fever or is unable to tolerate PO liquids