The optimal strategy for choosing antibiotics in patients with UTIs is:
A. Use local antibiograms to select a well-tolerated agent with a relatively narrow spectrum.
B. Minimize treatment failures by using amoxicillin/clavulanate for non–penicillin-allergic patients and levofloxacin for penicillin-allergic patients.
C. Await urine culture results before starting therapy to ensure that a proper drug is chosen.
D. Cover all nonallergic patients with IM ceftriaxone in the clinic, then await culture results to select an oral antibiotic.
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Answer: A. Local antibiograms are the preferred method to select appropriate antibiotic therapy in patients with UTI. They have been proven to decrease community antibiotic resistance, improve outcomes, and lower the cost of care. Choosing broad-spectrum antibiotics to empirically cover all UTIs has been shown to disrupt healthy bacterial flora, increase the presence of multidrug-resistant organisms, and increase the rate of complications like Clostridium difficile colitis. Patients with clinical suspicion of UTI and a urine dipstick suggestive of infection should be treated empirically with antibiotics, whether or not a culture is sent. Delaying therapy to await culture results in these cases prolongs patient discomfort and increases the risk of complicated UTI development. While in-clinic IM ceftriaxone is a reasonable option to begin therapy in outpatient pyelonephritis, it is not the best strategy for all UTI patients. Even when used to initiate therapy in pyelonephritis cases, oral antibiotics should be prescribed at discharge and not delayed to await culture results.