Emergency Department MDM

34 yo F with PMH of recurrent UTIs presents to the ED with a 2-day history of dysuria, urinary frequency, and mild suprapubic discomfort, denying fever, chills, flank pain, or vaginal discharge. Vitals are WNL (T 36.8 °C, HR 78 bpm, BP 118/74 mmHg); physical exam reveals mild suprapubic tenderness without CVA tenderness, and UA is positive for leukocyte esterase, nitrites, and > 50 WBC/hpf, with a negative urine HCG.

Reassessment

• Laboratory results were reviewed with the patient and the next steps in management were discussed.
• Shared decision-making was utilized to confirm that the patient felt comfortable with the plan and agreed to discharge.
• The patient reports significant improvement in her dysuria and suprapubic discomfort following ED administration of phenazopyridine 200 mg PO and ibuprofen 400 mg PO.

Plan for Patient

• Discharge on nitrofurantoin (Macrobid®) 100 mg PO BID for 5 days for acute uncomplicated cystitis, along with phenazopyridine (Pyridium®) 200 mg PO TID PRN for 2 days for dysuria.
• Follow up with primary care provider in 3–5 days if symptoms do not completely resolve.
• Educated on strict return precautions, including instructions to return to the ED immediately for fever, rigors, flank pain, intractable nausea/vomiting, or inability to tolerate oral fluids.
• Started nitrofurantoin 100 mg PO BID; continue home oral contraceptive pills without changes.
• Increase oral fluid intake, particularly water, and practice post-coital voiding to reduce recurrence risk.