Recurrent UTI Following Incomplete Antibiotic Course - Treatment Dilemma
Case at a Glance
A 23-year-old female presents with recurrent urinary tract infection symptoms two days after completing an inconsistently taken course of nitrofurantoin, now prescribed ciprofloxacin but expressing concerns about fluoroquinolone adverse effects.
Patient's Story
The patient initially presented to urgent care two weeks prior with classic UTI symptoms and was prescribed a 7-day course of nitrofurantoin (Macrobid). She admits to poor medication adherence, including missing an entire day of treatment, taking only single doses on some days instead of the prescribed twice-daily regimen, and consuming alcohol during treatment. Two days after completing the course, her UTI symptoms returned with significant bladder pressure and discomfort. She returned to urgent care due to her gynecologist's unavailability and was prescribed a 5-day course of ciprofloxacin.
Initial Assessment
Patient is a 23-year-old female with a history of hypothyroidism presenting with recurrent UTI symptoms. Vital signs: Height 5'5", Weight 140 lbs. She reports bladder pressure, discomfort, and urinary symptoms consistent with cystitis. Medical history significant for hypothyroidism and previous UTIs.
The Diagnostic Journey
Initial diagnosis was based on clinical presentation consistent with uncomplicated UTI. The patient's symptoms resolved during nitrofurantoin treatment but recurred shortly after course completion, likely due to incomplete bacterial eradication secondary to poor adherence. Urgent care provider prescribed ciprofloxacin as second-line therapy.
Final Diagnosis
Recurrent uncomplicated urinary tract infection, likely due to incomplete treatment of initial infection secondary to medication non-adherence.
Treatment Plan
Patient was prescribed ciprofloxacin 500mg twice daily for 5 days. However, she expressed significant concerns about fluoroquinolone adverse effects and requested alternative treatment options. Patient self-administered a dose of previously prescribed nitrofurantoin and planned to consult with gynecologist for alternative antibiotic therapy.
Outcome and Follow-up
Patient education provided regarding the importance of medication adherence and the risk of antibiotic resistance with incomplete treatment courses. Recommended follow-up with gynecologist for culture-guided therapy and consideration of alternative antibiotics such as trimethoprim-sulfamethoxazole or cephalexin, depending on local resistance patterns and patient tolerance.