This document provides information about a 64-year-old female patient admitted to the hospital for urinary tract infection (UTI), rheumatoid arthritis (RA), diabetes mellitus (DM), and hypothyroidism. The patient was experiencing pain while urinating, fever, and vomiting. Diagnostic tests confirmed UTI and the presence of Klebsiella pneumoniae bacteria. The patient was started on a regimen of antibiotics, analgesics, antipyretics, and medications for her underlying conditions. Her symptoms improved over the course of her hospital stay and she was discharged with medications to continue treatment.

1. Submitted by : Amar Prasad Chaudhary
III PHARM-D
Department of clinical practice,
MALLIGE COLLEGE OF PHARMACY,Silvepura,Bangalore-90

2. URINARY TRACT INFECTION(UTI)
 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.[1] 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. Although they cause discomfort, urinary tract
infections can usually be quickly and easily treated with a short
course of antibiotics.
 Sign and symptom of UTI are gross hematuria, nocturia, dysuria,
suprapubic heaviness, nausea , fever, vomiting

3. DEMOGRAPHIC DETAILS
 Patient name : xyz
 Age : 64 yrs
 sex : Female
 Department / ward : General / VIP
 DOA : 2-july-2017
 DOD : 8-july-2017

4. SUBJECTIVE EVIDENCE
COMPLAINTS ON ADMISSION ( C/O )
 Pain while passing urine since 15 days
 Fever along with chills (high grade)
 vomiting

5. PAST MEDICAL HISTORY
 Diabetes mellitus ( DM type 2 ) since 2 year
 Hypothyroidism since 3 years
 Rheumatoid arthritis (RA)
Family history
 Patient sister is diabetic
MEDICATION HISTORY
BRAND NAME GENERIC NAME DOSE FREQUENCY TIME
T.Glycomet Metformin 500mg 1-0-1 30 min before food
T.Thyronorm levothyroxine 25mcg 1-0-0 Empty stomach

6. SOCIAL HISTORY
 Appetite : normal
 Bowel and bladder : normal
 Sleep: normal
 Diet : veg

7. General physical examination
 PICCLE : Absent
 BP : 110/70 mm Hg
 RR : 20 c/min
 Pulse : 98 beats / min
 SpO2 : 98%@room air / Fio2
SYSTEMIC EXAMINATION
 CVS : S1S2 ( + )
 PA : SOFT
 RS : B/L NVBS (+)
 CNS : Conscious oriented

8. Provisional diagnosis
 Chronic urinary tract infection ,
 fibroid uterus

9. BIOCHEMICAL INVESTIGATION
 HAEMATOLOGY
 RBC : 3.6 Million cells /cumm ( 4.5 – 5.6 millcell/cumm )
 Monocytes : 12% (2%-10%)
 Lymphocytes : 13 % (20%-40%)
 Hemoglobin : 11.1 g % (14gm/dl – 18gm/dl )
 PCV : 33% ( 40% -54% )
 ESR : 50 mm/hr ( 0mm/hr-22mm/hr)
BLOOD SUGAR
 RBS : 228 mg/dl (70-120)

10. URINE ANALYSIS
 Colour : yellow
 Appearance : turbid
 WBC : present
 Sugar : present
 Epithelial cell : 3-4 cells
 Bacteria : present
 Nitrite : positive
 pH : acidic 6.0

11. ANTIMICROBIAL SENSITIVITY TEST
 Organism : klebsilla pneumoniae
 Antimicrobial
sensitive to only (4-7-2017)
 Poymixin B
 colistin

12. Final diagnosis
 From subjective and objective evidence it
is confirmed that patient is suffering form
 UTI
 RA
 DM and
 hypothyroidism.

13. GOALS OF THERAPY
 To reduce the sign and symptom of the disease
 To prevent the further complication of the disease
 To cure the infection
ASSESSMENT OF CURRENT THERAPY

14. MEDICATION TREATMENT CHART
Date Brand name Generic name indication Dose Route frequency Time End date
3/7/017 T.PCT PARACETAMOL Antipyretic 650mg PO SOS After food 8-7-2017
3/7/017 SYP.citralika DISODIUM
HYDROGEN cit.
Alkalizer 2 tsp PO TID After food 5-7-2017
3/7/017 T.URISPAS FLAVOXATE HCL Smooth muscle
relaxant
200mg PO SOS After food 5-7-2017
3/7/017 INJ.EMESET ONDANSETRON Anti emetic 4mg IV SOS 5-7-2017
3/7/017 INJ.
PANTODAC
PANTOPRAZOLE PPI 40mg IV 1-0-0 8-7-2017
3/7/017 INJ.ZOSTUM CEFOPERAZONE Antibiotic 1.5gm IV 1-0-1 4-7-2017
3/7/017 T.GLYCOMET METFORMIN DM 500mg PO 1-0-1 before
food
8-7-2017
3/7/017 T.THYRONO
RM
LEVOTHROXINE Hypothyroidism 25mcg PO 1-0-0 Empty
stomach
8-7-2017

15. Date Brand name Generic
name
indication Dose Route frequency Time End date
3/7/017 T.HCQ’S HYDROXYCH
LOROQUINE
RA 200mg PO 1-0-0 After food 8-7-2017
3/7/017 T.FOLIC ACID FOLIC ACID Vit B
supplimentA
RY
5mg PO 1-0-0 After food 8-7-2017
3/7/017 T.FOLITRAX METHOTREX
ATE
RA 2.5mg PO 1-0-0 After food 8-7-2017
3/7/017 EVALON
CREAM
OGESTRON,E
STROL
Vaginitis TOPICAL 1-0-1 8-7-2017
5/7/017 INJ.COLLISTI
N
COLLISTIN Antibiotic 2 mill.unit IV 1-0-1 8-7-2017
3/7/017 CAP.URIMAX TAMSULOSIN SMOOTH
MUSCLE
RELAXANT
0.4mg PO 0-0-1 After food 8-7-2017
3/7/017 T.NIFIRAN NITROFURAN
TION
UTI 100mg PO 0-0-1 After food 8-7-2017

16. PROGRESS CHART
PARAMETER DAY1 DAY2 DAY3 DAY4 DAY5
BP (mmhg) 110/70 110/80 120/80 130/70 120/80
Pulse (bpm) 98 80 74 72 82
Temp (F) 98.6 afebrile afebrile afebrile afebrile

17. DISCHARGE MEDICATION
BRAND
NAME
GENERIC NAME DOSE INDICATION FREQUEN
CY
TIME DURATION ROUTE
INJ.COLLISTIN COLLISTIN 2 MILL.
UNITES
UTI 1-0-1 4 days IV
T.GLYCOMET METFORMIN +
Glymperide
500MG +
12.5mg
DM 1-0-1 Before food Continue PO
T.THYRONORM LEVOTHROXINE 25mcg HYPOTHYRODISM 1-0-0 Empty
stomach
Continue PO
T.HCQ’S HYDROXY
CHLOROQUINE
200mg RA 1-0-0 After food Mon,wed,fri PO
T.FOLIC ACID FOLIC ACID 5mg VIT. SUPPLY 1-0-0 After food Mon,wed,fri PO
T.FOLITRAX METHOTREXATE 2.5mg RA 1-0-1 After food Sun PO
SYP.CITRULIKA DISODIUM
HYDROGEN
CITRATE
2tsp ALKALIZER 1-1-1 After food 10days PO
T.NIFTRAN NITROFURANTION 100mg UTI 0-0-1 After food 4 days PO
T.PANTODAC PANTAPRAZOLE 40mg PPI 1-0-0 Before food 30 days PO
cap.URIMAX TAMSULOSIN 0.4mg Smooth muscle
relaxant
0-0-1 After food 10days PO

18. PHARMACIST INTERVENTION
DRUG INTERACTION
moderate
 LEVOTHYROXINE + METFORMIN
Levothyroxine may interfere with the blood glucose control and reduce the
effectiveness of metformin

19. Monitoring parameters
GENERIC NAME ADVERSE EFFECTS
COLLISTIN Nephrotoxicity , neurotoxicity , dizziness
DISODIUM HYDROGEN
citrate
Nausea, vomiting, diarrhea, stomach discomfort
FLAVOXATE HCL Dry mouth, nervousness, blurred vision
HYDROXY CHLOROQUINE Headache, ringing in ear , spinning sensation, skin rashes
METHOTREXATE Cardiovascular risk, mouth sores, black stools
NITROFURANTION Nausea, loss of appetite, dark urine
CEFEPERAZONE Neutropenia, hypersensitivity reaction, diarrhea
TAMSULOSIN Back pain , tooth problems , low sex drive, blurred vision

20. Patient counselling
Disease based
 Should drink water in more amount around 3 to 4 glasses
and urinate as soon as urge
 Reduce or restrict sweet , try to eat sugar free food
 Should go to physiotherapy which helps to reduce RA pain
 Should use ice pack in affected joints
 Try to do aerobic exercise and reduce some weight
Medication based
 Take pantoprazole 30 min before food
 Should take glycomet before food but not in empty
stomach
 Take levothyroxine in empty stomach