A 64-year-old female patient sought care for the treatment of a urinary tract infection, and her primary care provider prescribed nitrofurantoin. What change in the patient's health status would prompt the use of an alternative medication?
A) The patient develops a fluid volume deficit.
B) Urinalysis reveals the presence of ketones.
C) The patient develops leukocytosis.
D) The patient's UTI progresses to urosepsis.
D
Feedback:
Urinary antiseptics may be bactericidal for sensitive organisms in the urinary tract because these drugs are concentrated in renal tubules and reach high levels in urine. They are not used in systemic infections because they do not attain therapeutic plasma levels. Consequently, the development of urosepsis would necessitate a systemic antibiotic. Fluid deficit, ketones in the urine, and elevated white cells would not necessarily contraindicate the use of nitrofurantoin.
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