Emergency Department Discharge Guidance Template

Diagnosis

• Acute uncomplicated cystitis (urinary tract infection)

Results

• Urinalysis: Positive for leukocyte esterase, nitrites, and trace hematuria. Urine culture pending.
• Point-of-care urine pregnancy test: Negative.

Treatment

• Administered phenazopyridine (Pyridium®) 200 mg PO x 1 for dysuria and paracetamol (acetaminophen, Tylenol®) 1,000 mg PO x 1 for suprapubic discomfort.

Prescribed Medications

• nitrofurantoin (Macrobid®) 100 mg PO BID for 5 days. Take with food or milk to improve absorption and decrease stomach upset. Common side effects include nausea, headache, and harmless brown/rust-colored urine.
• phenazopyridine (Pyridium®) 200 mg PO TID PRN for urinary pain for up to 2 days. Take with or after meals and with a full glass of water. This medication will turn your urine bright orange or red, which may stain clothing or contact lenses.

Return Precautions

Return to the Emergency Department if you experience any of the following

• High fever (> 38.0 °C / 100.4 °F) or shaking chills
• New or worsening back, flank, or side pain
• Persistent nausea and vomiting that prevents you from keeping fluids or medications down
• Inability to pass urine
• Worsening symptoms despite 48 hours of antibiotic therapy

Patient Education

• Complete the full 5-day course of nitrofurantoin even if your symptoms resolve earlier.
• Increase oral fluid intake (especially water) over the next several days to help flush bacteria from the urinary tract.
• Avoid bladder irritants such as caffeine, alcohol, carbonated beverages, and spicy foods until symptoms resolve.
• Urinate frequently and immediately after sexual intercourse; always wipe from front to back.

Follow-Up Care

• Follow up with your primary care provider or specialist as recommended.
• Schedule an appointment with your Family Medicine clinic in 3 to 5 days if symptoms do not completely resolve, or sooner if notified of an abnormal urine culture result requiring an antibiotic change.