Jessica Jetson is a 10 year old Caucasian female with
her first urinary tract infection. Her urine dipstick is positive
for leukocyte esterase and for nitrites. She has no fever or flank
pain. She gets hives when she takes penicillin. She weighs 60 pounds
and is 48 inches tall.
J.J. is allergic to penicillin (she gets hives) , therefore all members
of the penicillin family including ampicillin, amoxicillin, and Augmentin
are contraindicated. Since penicillins and cephalosporins have a 10%
cross-reactivity rate, I would avoid cephalexin unless there was no
other good choice. Ciprofloxacin is not approved for use in children
under 18 years for urinary tract infections because of tendon alterations
in juvenile lab animals so I would avoid that drug. Both SMX/TMP and
nitrofurantoin can be used safely, however SMX/TMP is much less expensive
and commonly used in children. SMX/TMP is effective against most common
causes of UTI, the aerobic enteric pathogens excluding only pseudomonas.
Children need to complete a 10-day course. Lehne, 3rd ed. PP 900-901.
NP Drug handbook, 2nd ed. pp.: 1000-2, 1082-83, 59-62, 67-9, 203-4,
- Sulfamethoxasole/trimethoprim (200mg/40mg) per 5 ml suspension
- Take 15 mls ( 3 teaspoons) every twelve hours for ten days
- Dispense 300 mls
- No refills.
Rationale for Amount Rx'd
300 mls is the amount needed to complete this course of
medication as furnished.
SMX/TMP affect the metabolism of anticoagulants, increasing
the effect of the anticoagulants by displacing them from protein binding
sites during hepatic metabolism, so warfarin levels should be checked
during therapy. Drug levels of sulfonureas may also be elevated by a
similar mechanism so hypoglycemia may occur, and sulfonurea doses may
need to be adjusted downward. Other highly protein bound drugs such
as cyclosporine, methotrexate, and phenytoin may be displaced, raising
free drug levels and possibly toxicity of these drugs.
These may include allergic skin reactions: rash, urticaria, photosensitivity;
nausea, vomiting, blood dyscrasias, hepatitis, Steven-Johnson syndrome,
toxic epidermal necrolysis, as well as (rarely) confusion, depression,
hallucinations, seizures, fever, ataxia, stomatitis, diarrhea, colitis,
thrombocytopenia, megaloblastic anemia, granulocytopenia, aplastic anemia,
hemolysis in persons with G6PD deficiency, kernicterus in newborns,
and insterstitial nephritis.
Patient Instructions and Education
Take medication on an empty stomach with a full 8-ounce glass of water
one hour before or two hours after meals. Don't skip doses. Do finish
all the medicine. Wear sunscreen and protective clothing in case of
photosensitivity. Small frequent meals and hard candy may decrease nausea
if this occurs. Drink increased fluids throughout the day to help flush
bacteria away and bring the medicine to the bladder. Report any unusual
skin rash, bleeding, bruising or sore throat to your practitioner right
Frankel, RN, MSN, C FNP
Office: (707) 664-2640 | Home: (415) 663-1855 | Fax: (707) 664-2653
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