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Uncomplicated cystitis — USMLE Step 3 MCQ

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HardAmbulatory Medicine / Primary CareUncomplicated cystitisUSMLE Step 3

A nonpregnant woman has fever 38.8°C, nausea, dysuria and right costovertebral-angle tenderness. Urinalysis shows pyuria and nitrites. Which proposed outpatient drug is inappropriate even if the isolate is susceptible in vitro?

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Correct answer: C — Use oral nitrofurantoin as definitive therapy for this suspected pyelonephritis

The best answer is “Use oral nitrofurantoin as definitive therapy for this suspected pyelonephritis”. This syndrome is pyelonephritis, not lower-tract cystitis. Nitrofurantoin concentrates in urine but does not achieve adequate renal-parenchymal levels, so it must not be used to treat pyelonephritis. Nitrofurantoin is appropriate for lower-tract cystitis but should not be used when pyelonephritis is suspected because renal-tissue concentrations are inadequate.

Reference: IDSA Guideline: Acute Uncomplicated Cystitis and Pyelonephritis in Women: https://www.idsociety.org/practice-guideline/uncomplicated-cystitis-and-pyelonephritis-uti/