Tunyapon Sasithorn Kay

Case # 32Pharmacology clinical case

Case # 32

• JV a 23 y/o female, single was seen at the OPD because of dysuria , frequency, urgency and suprapubic pain. Urinalysis revealed UTI

UTI

A urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary tract. Although urine contains a variety of fluids, salts, and waste products, it usually does not have bacteria in it. When bacteria get into the bladder or kidney and multiply in the urine, they cause a UTI. The most common type of UTI is a bladder infection which is also often called cystitis. Another kind of UTI is a kidney infection, known as pyelonephritis, and is much more serious.

Signs and symptoms•For Kidney Infections

•The above symptoms. •Emesis: Vomiting is common. •Back, side (flank) or groin pain. •Abdominal pain or pressure. •Shaking chills. •Night Sweats. •Extreme Fatigue.

•For Bladder Infections

•Frequent urination along with the feeling of having to micturate even though little or no urine actually comes out. •Nocturia: Need to urinate during the night. •Urethritis: Discomfort or pain at the urethral meatus or a burning sensation throughout the urethra with micturition (dysuria). •Cystitis: Pain in the midline suprapubic region. •Pyuria/Hematuria: Pus or blood in urine. •Pyrexia: Mild fever •Discharge from the urethra. •Cloudy and foul-smelling urine •Some urinary tract infections are asymptomatic

Diagnosis

• A patient with dysuria (painful voiding) and urinary frequency will generally have a mid-stream urine sample sent for urinalysis.

• The diagnosis of UTI is confirmed by a urine culture.

• Specific finding will include the presence of nitrates, bacterias, leukocytes or leukocyte esterase.

Differential diagnosis

•Bladder cancer •Frequent urination•Pain during urination, •Blood in the urine (making the urine slightly rusty to deep red)

•Urethral syndrome•Dysuria •Urgency •Nocturia •Urinary frequency•Urethral discomfort •Painful urination •Urinary symptoms worsened by sex •No bacteria in urine•Have no bacterial infection •No pus in urine •No lower abdominal pain •No fever•Pelvic pain •Slowing of your urinary stream

Treatment

•amoxicillin (Amoxil, Trimox), •nitrofurantoin (Furadantin, Macrodantin),•trimethoprim (Proloprim)

•Antibiotic combination:trimethoprim and sulfamethoxazole

(Bactrim, Septra)

•Drugs most commonly recommended for simple UTIs include

Management and prevention

You can take steps to reduce your risk of urinary tract infections.

• Drink plenty of liquids, especially water. Cranberry juice may have infection-fighting properties. However, don't drink cranberry juice if you're taking the blood-thinning medication warfarin. Possible interactions between cranberry juice and warfarin can lead to bleeding.

• Urinate promptly when the urge arises. Avoid retaining your urine for a long time after you feel the urge to void.

• Wipe from front to back. Doing so after urinating and after a bowel movement helps prevent bacteria in the anal region from spreadinganal region from spreading to the vagina and urethra.

• Empty your bladder as soon as possible after intercourse. Also, drink a full glass of water to help flush bacteria.

• Avoid potentially irritating feminine products. Using deodorant sprays or other feminine products, such as douches and powders, in the genital area can irritate the urethra

Thank you