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  1. #1
    Monsoonrain's Avatar
    Monsoonrain is offline Member 510 points
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    Which antibiotic should be used?

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    A G1P1 38 weeks of gestation, on her Urine culture grows >100,000/colony with E. Coli.Which antibiotic should be used?
    a)Ciprofloxacin
    b)Bactrim
    c)Clindamycin
    d)Amoxicillin
    Prevention is better than cure

  2. #2
    ravipatel529 is offline Newbie 510 points
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    Bactrim.
    i think it should be bactrim as its second choice after nitrofurantoin....and she has 38 week gestation,no risk

  3. #3
    Ojelade's Avatar
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    This is a pregnant woman - you want to be careful in the first and third trimesters. From the question she is in her 3rd trimester. A good choice will be a drug that is safe in pregnancy and is also effective against E.coli like amoxicillin, ampicillin, nitrofurantoin, or an oral cephalosporin.

  4. #4
    IMG SURVIVOR's Avatar
    IMG SURVIVOR is offline Moderator 536 points
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    D for the safety of the child.
    Moderator: USMLE AND Residency Forums.

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    why even bother with the obvious. Just know where you are need it and where you can help the most.

  5. #5
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    student-2 is offline Senior Member 510 points
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    D all the way!!! "Aminocillins" are commonly used in pregnancy, also used with Clinda (mainly Ampi) for broad coverage when chorioamnionitis is feared

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    SPODAT's Avatar
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    Harrisons says Amoxicillin for uncomplicated, and Nitrofurantoin for reoccuring. Epocrates (5 Min Clin Consult) says Quinilones (Ciprofoloxacin) is currently the DOC for uncomplited UTI in pregnancy. Bactrim is contraindicate in pregnancy, clindamycin is not doc for UTI.

    If not pregnant it would be TMP/SMX, but it is also used even in pregnancy, against box reccomendation.

  7. #7
    vishalforyou is offline Newbie 511 points
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    cipro in Contraindicated in pregnancy and children bcoz of cartilage damage..38 weeks is ok but amoxicillin is a better choice..i'll go for D

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    SPODAT's Avatar
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    It is really very interesting how actual practice differs with what we are trying to decipher from books and refferences. Like the idea of no quinilones due to the cartilage/tendon issue is a hot board topic, but actually becomes a qualitative decision pretty rare occurence in clinical practice, and often outweighs the AE's of other similarly used meds.

    My kid's docs have prescriped augmentin, cipro, and keflex at various times.

    here's a citation...

    JOHN E. DELZELL, JR., M.D., and
    MICHAEL L. LEFEVRE, M.D., M.S.P.H. University of Missouri-Columbia School of Medicine, Columbia, Missouri
    Urinary tract infections are common during pregnancy, and the most common causative organism is Escherichia coli. Asymptomatic bacteriuria can lead to the development of cystitis or pyelonephritis. All pregnant women should be screened for bacteriuria and subsequently treated with antibiotics such as nitrofurantoin, sulfisoxazole or cephalexin. Ampicillin should no longer be used in the treatment of asymptomatic bacteriuria because of high rates of resistance. Pyelonephritis can be a life-threatening illness, with increased risk of perinatal and neonatal morbidity. Recurrent infections are common during pregnancy and require prophylactic treatment. Pregnant women with urinary group B streptococcal infection should be treated and should receive intrapartum prophylactic therapy. (Am Fam Physician 2000;61:713-21.)

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