CASE STUDY ON Urinary Tract Infection

1. Presented By:
MAKBUL HUSSAIN CHOWDHURY
Pharm. D 4th Year

2.  UTIs are common, especially among women
* UTIs in men are less common and primarily
occur after 50 years of age
* UTIs infection usually occur by ascending route
(urethra to bladder)
* UTIs infection is less common by haematogenous
spread (kidney)
* UTIs occur in two general settings: community-
acquired and hospital acquired.

3. * Urethritis : Infection of anterior urethral tract
dysuria, urgency
and frequency of micturition
- Dysuria ;(burning pain on passing urine)
- Urgency ;(the urgent need to pas urine)
- Frequency of micturition
* Cystitis : Infection of urinary bladder
dysuria, frequency, pyuria and
haematuria
*Bacteriuria: Presence of bacteria in urine
A count of 100 organisms/ml or more in urine
* Pyuria : Presence of pus in urine
(more than 10 cells/HPF)
Pyelonephritis: Infection of kidney ; flank pain,
pyuria, fever, chills, nausea

4. Clinical Features
Acute lower UTIs (Urithritis and cystitis):
Rapid onset of:
- Dysuria (burning pain on
passing urine)
- Urgency (the urgent need to
pas urine)
- Frequency of micturition
Upper UTIs (Pyelonephritis):
- Fever
- Chills
- Dysuria
- Urgency
- Frequency of micturition
Etiology Of Urinary Tract Infections
Causative organisms:
1- Bacterial
2- Viral
3- Fungal
4- Protozoal

5. 1. Sex
2. Anatomy and Physiology of woman’s organ.
3. Urinary Catheters.
4. In Children’s; Due to Vesicoureteral reflux.
5. Hyperplasia: causes obstruction of the uretra.
6. Diabetes.

7.  CR No. : 8621/13
 Age : 30 y
 Sex : M
 DOA : 29/11/17
 DOD : 04/12/17
( No. of days in hospital = 05 )

8.  Fever with high grade chills
Headache & body-ache (since last 07 days).
 Loose stools (since last 02 days).
 Vomiting (2-3 episodes)

9.  No history of DM or TB or HTN.
 Family history: Not significant.
 Social history : No history of addiction.
 Vegetarian.
 Non-smoker.

10.  BP = 130/90 mmHg
 Temp. = 100.2◦ F
 RR = 24/min
 PR = 108/min

11. LAB. TEST
PARAMETERS
RESULTS NORMAL
VALUES
Total Bilirubin 0.8 mg/dl 0.2-1.3 (Adults)
1.0-10.5(Neonates)
Serum Potassium 3.8 mmol/L 3.5-5.1 mmol/L
Serum Sodium 135mmol/L 137-145 mmol/L
Serum SGOT 44 IU/L 14-36 IU/L (F)
17-59 IU/L (M)
Serum SGPT 59 IU/L 9-52 IU/L (F)
21-72 IU/L (M)
Serum BUN 13 mg/dl 7-17 mg/dl (F)
9-20 mg/dl (M)

12. Test parameters Results Normal Values
Hb.(g/dl) 13.6 11.5-16.5
TLC (/cumm.) 5300 4000-11000
Neutrophils (%) 65 40-75
Lymphocytes (%) 32 20-45
Eosinophils (%) 00 01-06
Monocytes (%) 02 02-10
Basophils (%) 00 0-2
RBC(million/cumm.) 4.41 3.8-4.8
Platelet(lacs/cumm.) 1.5 1.5-4.0
MCV 90.2 0-20

13. Diagnostic tests;
 On 30-11-2017 Test for (MP antigen) : negative
 Widal = negative
 Urine Microscopic examination- 30-11-17
Pus cells- 6-10cells/hpf (occasional clumf)
Epithelial cells- 2-3/hpf

15.  Based on the reports of routine urine examination
and microscopy, the present case was diagnosed as that
of Urinary tract infection on 31/05/13.

16.  To lower the body temp.
 To provide the relief from headache and body-ache
 Prevention of vomiting.
To eradicate the infection of Urinary tract and to
prevent the chances of relapse.

17. Day &
symptoms
Medication
withdrawn
Medication Added
Day 01
(30.11.17)
Fever with high
grade chills,
headache and
body-ache,
yellowish
discoloration of
sclera, vomiting
and loose stools.
(PR= 76/min,
RR= 22/min,
BP=120/80
Temp. 101.6F)
Inj. Mole (stat) (paracetamol)
Inj.Palin 40mg, IV,BD(pantaprazole)
Inj.Geminate plus 1.5gm, TDS, IV,
(ceftriaxone)
Syp. Rqual, 2tsf,TDS (multivitamins)

18. Day &
symptoms
Medication
withdrawn
Medication added
Day 02
(1.12.17)
at 4pm
(PR= 88/min,
RR= 22/min,
BP=130/90
Temp. 102.6F)
Adv. – Routine urine examination and
microscopy.
Rx,
tab. Lariago-DS 2 tb stat
tb 1 after 6 hr.

19. Day & Symptoms Medication
Withdrawn
Medication Added
DAY 03 (02.11.17)
(BP=120/80mmHg
PR=86/min,
RR=22/min
Temp=98.4F)
GC stable,
At 5pm Temp.99.6F
CST
Tb. Calpol given
DAY 04 (02.06.13)
(BP=110/80mmHg
PR=76/min,
RR=22/min
Temp=98F)
GC stable,
tb.
Lariago
Adv. TLC
tb. Norflox, 400mg , BD
(norfloxacin)
syp. Alkasol, 2tsf, TDS
(disodium citrate)
tb. Sibelium, 10mg, HS
(flunarizine)

20. Day & symptoms Medication
withdrawn
Medication added
DAY 05 (3.12.17)
(BP=130/80mmHg
PR=72/min, RR=22/min
Temp=98F)
GC stable,
No fresh complaint
DAY 06 (04.06.13)
(BP=120/70mmHg
PR=80/min, RR=20/min
Temp=98.6F)
GC stable,
No fresh complaint
CST
Patient discharged
TLC reports =5600

21. DAY OF DISCHARGE (4.12.17) – Condition of the patient
improved and prescription revised for discharge.
Discharge summary is as follows:
1. Tab. Pantocid 400mg BD
2. Tab. Norflox 400mg BD
3. Syp. Alkasol 2tsf TDS
4. Syp. Rqual 2tsf TDS
All medications for 5 days.
Advice to repeat Routine Urine Examination & Microscopy
tests and follow up after 5 days.

22. The treatment given to the patient was almost
satisfactory and the condition of patient was improved at
the time of discharge but apart from this there are some
instead that are:
Tab. Lariago was given irrationally because if there was
a negative test report of malarial parasite then why that
particular drug was prescribed.

23.  Patient case record.
 Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG,
Posey LM. Pharmacotherapy:A Pathophysiologic
Approach. 6th ed. New York: The McGraw-Hill
Companies; 2005.
www.elsevierimages.com accessed on 02.06.13