A 38-year-old woman, gravida 5 para 4, at 10 weeks gestation comes to the office for a routine prenatal visit. The patient reports no
urinary frequency, hematuria, or dysuria She feels well and has Ino concerns. The patient takes prenatal vitamins and has a history
of type 2 diabetes mellitus currently being managed with insulin. She does not use tobacco, alcohol, or illicit drugs. Temperature is
36.7 C (98 F) and blood pressure is 130/80 mm Hg BMI is 29 kg/m2• The fetal heart rate is 155/min by Doppler ultrasound. Physical
examination shows no abnormalities. Laboratory results from the patient's initial prenatal visit 2 weeks ago show that a clean catch
urine culture grew >100,000 colony-forming units/ml of Escherichia coli. Which of the following is the best next step in management
of this patient?
0 A Amoxicillin-clavulanate
Q B. Ciprofloxacin
O C. Doxycycline
O D. No additional treatment or workup indicated
O E. Trimethoprim-sulfamethoxazole
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