First ALiEM journal article: Trial of void for acute urinary retention

A patient may present to the ED after foley catheter placement for acute urinary retention (AUR) a few days ago and now requests catheter removal. Ideally this should be performed in the urologist’s office. However, occasionally patients cannot or do not follow up with the urologist in a timely manner and return to the ED expecting urethral catheter removal. A careful history and physical should be performed along with a consulting urologist. If the eventual decision is to remove the urethral catheter in the ED, what is important to know about a Trial of Void (TOV)?

By |2018-01-30T01:58:58-08:00Mar 19, 2013|Genitourinary|

Paucis Verbis: Genital Ulcers

A few months ago, American Family Physician published a nice review article on the diagnosis and management of genital ulcers. How do you remember the classic appearances of the lesions? I often quickly check references to confirm my suspicions.

I find the two following tables helpful to remember. The table of differential diagnoses is from AFP. The article also reviews the confirmatory diagnostic testing and treatment protocols. The table of the clinical characteristics for the main infectious causes is from “The Practitioner’s Handbook for the Management of Sexually Transmitted Disease”.

Note: Although the primary lesion from Lymphogranuloma venereum (LGV) can have a variable appearance the tender, and often suppurative lymphadenopathy (buboes) are classic.

genital ulcers

PV Card: Genital Ulcers


Adapted from [1]
Go to ALiEM (PV) Cards for more resources.

Most recent 2010 CDC treatment guidelines

Reference

  1. Roett M, Mayor M, Uduhiri K. Diagnosis and management of genital ulcers. Am Fam Physician. 2012;85(3):254-262. [PubMed]
By |2021-10-10T18:59:28-07:00May 4, 2012|ALiEM Cards, Genitourinary|

Paucis Verbis: Antibiotics for Cystitis and Pyelonephritis in Women

UrineBacteriaYou diagnose a 35 years old woman with uncomplicated cystitis. She is not diabetic and not pregnant. Which antibiotics should you give? What if she had pyelonephritis?

Answer: It depends on your local antibiogram.

San Francisco General Hospital 2010 Antibiogram

Today, go find out about your hospital’s local resistance rates for uropathogens to various antibiotics. For San Francisco General Hospital, I found our antibiogram publicly posted online. Urine isolates of E. coli demonstrate relatively high resistance rates to trimethoprim-sulfamethoxazole and ciprofloxacin:

  • Trimethoprim-sulfamethoxazole resistance rate = 33%
  • Cefazolin or Cephalexin resistance rate = 12%
  • Ciprofloxacin resistance rate = 16%

So based on the new 2010 practice guidelines by the ID Society of America and the European Society for Microbiology and Infectious Diseases,1 I should give:

  • Cystitis: Nitrofurantoin x 5 days, or cephalexin / beta-lactam x 3-7 days
  • Pyelonephritis: Ceftriaxone 1 gm IV x 1 + (ciprofloxacin x 7 days or trimethoprim-sulfamethoxazole x 14 days)

PV Card: Antibiotics for Uncomplicated Cystitis and Pyelonephritis in Women


Adapted from [1]
Go to ALiEM (PV) Cards for more resources.

Reference

  1. Gupta K, Hooton T, Naber K, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103-20. [PubMed]
By |2021-10-12T16:06:34-07:00Sep 2, 2011|ALiEM Cards, Genitourinary|
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