Case Studies

APRIL 16, 2014
Craig I. Coleman, PharmD
Case 1
SC is a 33-year-old woman who comes to your pharmacy’s urgent care clinic complaining of frequent painful urination and flank pain over her kidneys. She denies having fever, chills, nausea, or vomiting, and seems well hydrated. SC has no notable medical history and does not take prescription medications. The nurse at the pharmacy-based clinic performs a urine dipstick urinalysis, which has a positive result for bacteria and pyuria (white blood cells in the urine), and sends out a urine specimen for culture. The nurse makes a diagnosis of pyelonephritis and decides that SC can be treated as an outpatient. The nurse asks the pharmacist for advice regarding an empiric antibiotic regimen to treat SC.
What antibiotic should the pharmacist recommend for empiric therapy in SC?

Case 2
CC, a 38-year-old man, goes to his primary care physician complaining of insomnia. Upon questioning, CC notes that he has been having difficulty falling asleep almost every night for the past 4 weeks, but once he falls asleep, he sleeps through the remainder of the night. As a result of this sleep pattern, CC reports waking up tired and feels that his performance at work is beginning to suffer. CC travels frequently (2 to 3 times per month) and recently had a severe case of viral colitis that he acquired on a trip overseas. The colitis resulted in a 1-week hospital stay a few weeks ago, but the condition has completely resolved. CC has no other significant medical history and takes no prescription medications. His physician would like to use pharmacotherapy to treat the insomnia.
What agent(s) would you recommend to treat CC’s insomnia?

Dr. Coleman is professor of pharmacy practice, as well as codirector and methods-chief at Hartford Hospital Evidence-Based Practice Center, at the University of Connecticut School of Pharmacy.

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