A. Sexually active young women have the highest risk for UTIs. Their propensity to develop UTIs is caused by a short urethra, delays in micturition, sexual activity, and the use of diaphragms and spermicides.
C. A microscopic bacterial count of 100 CFU/mL of urine has a high positive predictive value for cystitis in symptomatic women. Ninety percent of uncomplicated cystitis episodes are caused by Escherichia coli, 10 to 20 percent are caused by coagulase-negative Staphylococcus saprophyticus and 5 percent are caused by other Enterobacteriaceae organisms or enterococci. Up to one-third of uropathogens are resistant to ampicillin, but the majority are susceptible to trimethoprim-sulfamethoxazole (85 to 95 percent) and fluoroquinolones (95 percent).
D. Young women with acute uncomplicated cystitis should receive urinalysis (examination of spun urine), and a dipstick test for leukocyte esterase.
E. A positive leukocyte esterase test has a reported of 75 to 90 percent in detecting pyuria associated with a UTI. The dipstick test for nitrite indicates bacteriuria. Enterococci, S. saprophyticus and Acinetobacter species produce false-negative results on nitrite testing.
F. Three-day antibiotic regimens appear to offer the optimal combination of convenience, low cost and efficacy comparable to seven-day or longer regimens.
G. Trimethoprim-sulfamethoxazole (Bactrim, Septra), 1 DS tab bid, remains the antibiotic of choice in the treatment of uncomplicated UTIs in young women.
H. The use of fluoroquinolones as first-line therapy for uncomplicated UTIs is recommended for patients who cannot tolerate sulfonamides or trimethoprim, who have a high frequency of antibiotic resistance because of recent antibiotic treatment, or who reside in an area with significant resistance to trimethoprim-sulfamethoxazole. Treatment should consist of a three-day regimens of one of the following:
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