A 64-Year-Old Man with a History of Benign Prostate Hyperplasia

A 64-year-old man with a history of benign prostate hyperplasia comes to the office with 2 days of dysuria, increased urinary frequency, and suprapubic discomfort.  The patient had similar symptoms 3 months ago and was treated with antibiotics.  This resolved his urinary symptoms, but he developed Clostridium difficile colitis, which necessitated oral vancomycin therapy.  The patient currently has no gastrointestinal symptoms.  His other medical problems include hypertension and hyperlipidemia.
Temperature is 37.6 C (99.8 F) , blood pressure is 124/72 mm Hg, and pulse is 86/min.  The abdomen is soft, nondistended, and nontender with normal bowel sounds.  There is no costovertebral angle tenderness.  The prostate is moderately enlarged, smooth, and nontender.
Urine dipstick is positive for leukocyte esterase and nitrite.  His previous urine culture had grown Escherichia coli, which was sensitive to all tested antibiotics.
Which of the following is the most appropriate initial antimicrobial therapy for this patient given his history of C difficile colitis?

A) Intravenous ceftriaxone
B) Oral amoxicillin-clavulanate
C) Oral ciprofloxacin
D) Oral nitrofurantoin
E) Oral trimethoprim-sulfamethoxazole

Correct Answer:

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