A male client with acute pyelonephritis receives a prescription for co-trimoxazole (Septra) P.O. twice daily for 10 days. Which finding best demonstrates that the client has followed the prescribed regimen?
A. Urine output increases to 2,000 ml/day.
B. Flank and abdominal discomfort decrease.
C. Bacteria are absent in urine culture.
D. The red blood cell (RBC) count is normal.
Correct Answer: C. Bacteria are absent on urine culture.
Co-trimoxazole is a sulfonamide antibiotic used to treat urinary tract infections. Therefore, the absence of bacteria on urine culture indicates that the drug has achieved its desired effect. The initial selection of antibiotics will be empiric and should be based on the local antibiotic resistance. Antibiotic therapy should then be adjusted based on the results of the urine culture.
Option A: Co-trimoxazole doesn’t affect urine output. Most uncomplicated cases of acute pyelonephritis will be caused by E. coli for which patients can be treated with oral cephalosporins or TMP-SMX for 14 days. Complicated cases of acute pyelonephritis require intravenous (IV) antibiotic treatment until there are clinical improvements.
Option B: Although flank pain may decrease as the infection resolves, this isn’t a reliable indicator of the drug’s effectiveness. When diagnosing acute pyelonephritis, keeping the differential broad is a wise idea. Physicians may consider other disorders as well when patients present with fever, flank pain, and costovertebral angle tenderness.
Option D: Follow-up for non-admitted patients for resolution of symptoms should be in 1 to 2 days. Follow-up urine culture results should be obtained only in patients who have a complicated course and are usually not needed in healthy, non-pregnant women.
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