AFP Clinical Answers
Heavy Menstrual Bleeding, Acute Pyelonephritis, Bacteriuria, IgA Vasculitis, Febrile UTIs
Am Fam Physician. 2021 Jul ;104(1):24.
Do nonsteroidal anti-inflammatory drugs effectively reduce heavy menstrual bleeding in premenopausal patients?
Nonsteroidal anti-inflammatory drugs are effective for reducing heavy menstrual bleeding in premenopausal patients with menorrhagia compared with placebo. However, nonsteroidal anti-inflammatory drugs are less effective than tranexamic acid (Cyklokapron) and the levonorgestrel-releasing intrauterine system (Mirena) for reducing heavy menstrual bleeding.
What are the appropriate first-line oral antibiotic therapies for uncomplicated acute pyelonephritis in women?
Fluoroquinolones (e.g., ciprofloxacin for seven days or levofloxacin [Levaquin] for five days) and trimethoprim/sulfamethoxazole for 14 days are appropriate first-line antibiotics for uncomplicated acute pyelonephritis in women when the causative organism is susceptible. Urine culture and antimicrobial susceptibility testing should be performed in patients with suspected acute pyelonephritis and used to direct antibiotic therapy.
Which patient populations should be screened for asymptomatic bacteriuria?
Patients who are pregnant should be screened for asymptomatic bacteriuria early in pregnancy and treated appropriately. Patients undergoing endourologic procedures associated with mucosal trauma (e.g., transurethral surgery) should be screened for asymptomatic bacteriuria before the procedure and treated appropriately. Healthy nonpregnant premenopausal patients should not be screened or treated for asymptomatic bacteriuria. Patients with diabetes mellitus should not be screened or treated for asymptomatic bacteriuria. Older patients with functional or cognitive impairment and bacteriuria but no systemic signs of infection who experience delirium or a fall should be assessed for other causes of delirium with careful observation rather than being treated with antimicrobials.
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