This document contains 4 case studies describing patients presenting with urinary tract infections (UTIs) or related conditions. For each case, a diagnosis is provided along with a request to prescribe a rational therapy. The responses provide treatment plans focusing on appropriate antibiotic choices and dosages to address the specific infections, along with counseling on potential side effects and follow up care.
This document contains 4 case studies describing patients presenting with urinary tract infections (UTIs) or related conditions. For each case, a diagnosis is provided along with a request to prescribe a rational therapy. The responses provide treatment plans focusing on appropriate antibiotic choices and dosages to address the specific infections, along with counseling on potential side effects and follow up care.
This document contains 4 case studies describing patients presenting with urinary tract infections (UTIs) or related conditions. For each case, a diagnosis is provided along with a request to prescribe a rational therapy. The responses provide treatment plans focusing on appropriate antibiotic choices and dosages to address the specific infections, along with counseling on potential side effects and follow up care.
This document contains 4 case studies describing patients presenting with urinary tract infections (UTIs) or related conditions. For each case, a diagnosis is provided along with a request to prescribe a rational therapy. The responses provide treatment plans focusing on appropriate antibiotic choices and dosages to address the specific infections, along with counseling on potential side effects and follow up care.
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Natasha Sangar Group 66 Faculty number 7344
Urinary tract infection case studies
1. A 33-year-old female complains of frequent urination (every 30–60 minutes during the day and at least three times each night), accompanied by pain, burning sensation and feeling of fullness of the bladder. The urine analysis with dipstick shows mild albuminuria and leukocyturia, single erythrocytes and bacteria. She had similar symptoms three months ago and was treated with sulfamethoxazole/trimethoprim for 5 days. No other comorbidities and allergies are reported anamnestically.
Diagnosis: Acute cystitis.
Prescribe a rational therapy.
ANSWER:
Aim: treat uncomplicated urinary tract infection
Reason for chosen drugs: - Fosfomycin: treat uncomplicated UTIs, first line treatment. Bacteriocidal drug that interferes with cell wall synthesis in both gram + and gram – bacteria - Co-trimoxazole not used due to increased resistance and side effects
Prescription:
RP/ Fosfomycini 3g D. scat No1 in sachets S. Dissolve 1 sachet in water, drink before bedtime #
- Inform patient of potential side effects:
o Fosfomycin: GI disturbances, skin reactions, dizziness - Use cautiously in elderly patients - If symptoms exacerbate go to emergency department
2. A 49-year-old female presents at the ER with a low back pain for 2 days, chills, elevated body temperature up to 38.7 ◦C. Earlier in the week she developed increased urinary frequency and dysuria. Recognizing the symptoms of UTI she took two days of SMX/TMP but was unable to finish the treatment because of nausea and vomiting. From the physical examination she looks unwell and appears uncomfortable, there is suprapubic tenderness and right costovertebral tenderness (positive succussio renalis). Urine microspic examination shows pyuria, hematuria, bacteriuria and single epithelial cells. The blood laboratory tests reveals elevated WBC count (18,3 G/L) with neutrophilia. Erythrocyte sedimentation rate (ESR) is 30 mm/h, but urea and creatinine are normal.
Diagnosis: Acute pyelonephritis.
Prescribe a rational therapy.
ANSWER: Natasha Sangar Group 66 Faculty number 7344
Aim: treat acute pyelonephritis ideally with single treatment
Reason for drug treatment: - Quinolones (Levofloxacin): Bactericidal IV infusion given to treat the severe infection of pneumonia - Antipyretic (Paracetamol): given to manage raised temperature, to give orally if patient stops vomiting
Prescriptions:
RP/ Levofloxacini 500mg/100ml
Da flac No1 S. Given intravenously once daily, for minimum 7 days #
RP/ Paracetamoli 500mg
Da scat no1 in tab S. Taken every 4-6 hours #
- Inform patient of possible side effects
o Levofloxacin: GI disturbances, dizziness, dyspnoea, QT interval prolongation o Paracetamol: Alter gut flora so can cause nausea, vomiting and diarrhoea - Check drug interactions: o Levifloxacin: ibuprofen, diclofenac, mefanamic acid (increased risk of seizures) o Paracetamol: alcohol – patient advised not to drink as can cause liver damage - Advise patient if symptoms exacerbate, to go to emergency department
3. A 22-year-old male complains of itching, burning sensation and pain during urination for 4 days. The only remarkable findings on the physical examination is that urethral meatus is red and swollen, constantly releasing secretions. An immunofluorescence study was performed in which Chlamydia trachomatis was visualized under ultraviolet light.
Diagnosis: Acute urethritis.
Prescribe a rational therapy.
ANSWER:
Aim: Treat chlamydia urethritis
Reason for chosen drugs: - Macrolide (Azithromycin): treats chlamydia and has prolonged action (bioavailability for 4-5 days)
Prescription:
RP/ Azithromycini 1g D. scat No1 in tab S. Take 1 tablet for 1 day only (single dose) # Natasha Sangar Group 66 Faculty number 7344
- Inform patient of possible side effects
o Azithromycin: GI disturbances, altered taste, vomiting - Check drug interactions with Digoxin (increases concentration) and Dabigatrin (increases exposure to it) - If symptoms exacerbate, go to emergency department
4. In a 26-year-old woman, pregnant in the 6th lunar month, a significant bacteriuria ≥ 105 CFU/ml of E. coli is found during a prophylactic examination. The woman has no subjective complaints. The examination is repeated after 2 days with the same result. There are no comorbidities, allergies and medications intake.
Diagnosis: Asymptomatic bacteriuria.
Prescribe a rational therapy.
ANSWER:
Aim: Treat asymptomatic bacteruria in pregnancy
Reason for chosen drug: - Fosfomycin: treat uncomplicated UTIs, first line treatment. Bacteriocidal drug that interferes with cell wall synthesis in both gram + and gram – bacteria
Prescription:
RP/ Fosfomycini 3g D. scat No1 in sachets S. Dissolve 1 sachet in water, before bedtime #
- Inform patient of potential side effects:
o Fosfomycin: GI disturbances, skin reactions, dizziness - If symptoms exacerbate go to emergency department
