Rosh Emergency Medicine Practice Test

Which medication is most appropriate for a pregnant woman being treated for dysuria, fever, and flank pain?

1. Intravenous ampicillin

2. Intravenous ceftriaxone

3. Intravenous ciprofloxacin

4. Intravenous tobramycin

The correct answer is: Intravenous ceftriaxone

In the context of treating a pregnant woman with dysuria, fever, and flank pain, the most appropriate medication is intravenous ceftriaxone. This choice is based on several factors related to both the efficacy of the drug and its safety profile during pregnancy. Ceftriaxone is a broad-spectrum cephalosporin antibiotic that is effective against the common pathogens associated with urinary tract infections, including those that can progress to pyelonephritis, which is indicated by fever and flank pain. It is particularly important to note that during pregnancy, certain antibiotics are favored due to their safety and low risk of adverse effects on the developing fetus. Ceftriaxone has a proven track record in managing serious infections in pregnant patients while also demonstrating a low incidence of teratogenic effects. This makes it suitable for use in this specific patient population where safety is paramount. In contrast, other medications in the list carry concerns. Intravenous ampicillin is effective but often not the first choice for serious infections requiring IV therapy. Intravenous ciprofloxacin, while effective for urinary infections, is a fluoroquinolone that is generally avoided during pregnancy due to potential risks of cartilage and bone development issues in the fetus. Intravenous to