60 year old female c/o persistent UTI symptoms after 72 hours of antibiotic therapy, what is your next step?
Further evaluation for complicated UTI-Urine Culture and sensitivity
if a 60-year-old female patient complains of persistent UTI symptoms despite 72 hours of antibiotic therapy, the next step would be to reassess the patient’s symptoms and gather additional information to determine the underlying cause.
1. Review the current antibiotics:
The first step is to evaluate the type of antibiotic therapy given and double-check whether the chosen drug was effective against the bacterial strains causing the UTI. If the patient received an inappropriate antibiotic, the treatment might need a change.
2. Collect urine culture and sensitivity:
The next step is to perform a urine culture and sensitivity test to determine the type of bacteria responsible for the UTI and its sensitivity to certain antibiotics. This step may involve repeat culturing of the urine sample in case the initial culture was inaccurate.
3. Check for underlying conditions:
The healthcare provider must investigate for any underlying condition that might be contributing to the recurrent UTIs. These include diabetes, bladder stones, kidney stones, and an obstruction of the urinary tract. Imaging studies such as ultrasound and CT scans, and blood tests may be used to facilitate diagnosis.
4. Review patient’s medical history and medication:
The healthcare provider must consider all the patient’s medical history and the medications they are on to rule out other possible causes of the persistent UTI.
5. Change medication if necessary:
Based on urine culture results, the healthcare provider may change the antibiotic if appropriate and prescribe the correct dosage and duration of treatment.
6. Provide patient education:
The healthcare provider may also provide patient education on the importance of proper hygiene, wiping from front to back, drinking plenty of water, and avoiding irritating feminine hygiene products.
Overall, the next step would be to reassess the patient fully and obtain all necessary information before deciding on the best course of action.
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