Question

Cysitis with possible Pyelonephritis:

J.S., a 65-year-old woman with diabetes, weeks treatment for dysuria, frequent urination, flank pain, and costovertebral angle tenderness. She has a temperature of 102°F, and under the microscope her spun urine contains a large number or leukocytes.

1. List the specific goals for treatment for J.S.
2. What drug therapy would you prescribe? Why?
3. What are the parameters for monitoring the success of therapy?
4. Discuss specific patient education based on the prescribed therapy.
5. List one or two adverse reactions for the selected agent that would cause you to change therapy.
6. What would be the choice for second-line therapy?
7. What over-the-counter and/or alternative medications would be appropriate for J.S.?
8. What lifestyle changes would you recommend to J.S.?
9. Describe one or two drug-drug or drug-food interactions for the selected agent.

Answer 1

CYSTITIS WITH POSSIBLE PYELONEPHRITIS

Goal Of Treatment

To eradicate infection

Provide symptomatic pain rellief

Early treatment to prevent risk of progression to  pyelonephritis

DRUG THERAPY

Antibiotics are the first course of action because untreated urinary tract infection leads to pyelonephritis [Presents of large  WBC in urine is because of bacterial infection]

The antibiotic options are

fosfomycin

Levofloxacin ,ciprofloxacin ,co-trimoxazole ,ampicillin

PARAMETERS FOR MONITORING SUCESS OF THERAPY

Symptoms began to improve after one or two days of treatment with antibiotics .However ,even,after symptoms improve ,antibiotics are usually prescribed to complete a10 to 14 day course

The sucess of antibiotic therapy can be estimated by factors such as ,

The minimal inhibitory concentration of the clinical isolates

The protein binding of the treatment

The pharmacokinetic and pharmacodynamic profile

PATIENT EDUCATION

Do not stop the medication after symptoms improve it have to be continued for prescribed course

take medication [levofloxacin ]with water,at the same time each day

drink extra fluids to keep kidney working properly

take levofloxacin one hour before or 2 hours after a meal

Donot take antacids that contain magnesium or aluminium because it can make levofloxacin much less effective when taken at the same time  

Do not take ulcer medicine sucralfate [carafate ] at the same of levofloxacin because it can also decrese the action of levofloxacin

ADVERSE REACTION

Levofloxacin can cause common side effect such as diarrhoea  

rare side effects are-agitation,blisters ,confusion, tenditis ,tendon ruptor ,skin rash ,trembling

SECOND LINE THERAPY

FOSFOMYCIN is a antibiotic to treat bladder infections

side effects are ,blood in urine ,burning while urinating ,difficult or pain full urination  

LIFE STYLE CHANGES

DRINK several glass of water

for woman,wipe from front to back after having a bowel movement or urinating

educate the patient to urinate after sexual intercourse

fosomycin can interact with metoclopramide and tyhpoid vaccine [live]