| Learning Objective #1: Identify four reasons for the high microorganism resistance rate to antibiotics used in managing uncomplicated urinary tract infection | |||
| Learning Objective #2: Describe the appropriate practice protocol for management of uncomplicated urinary tract infection of two different patient presentations |
Problem - There is a discrepancy in management of uncomplicated urinary tract infections(UTI). Practice differs regarding diagnostics,antibiotic, and follow-up. There is a documented rise in drug resistant pathogens especially regarding Escherichia coli and Trimethoprim-sulfamethoxazole which has led to the almost exclusive use of macrolides. Results -A chart audit and analysis of 204 clinic patients with documented UTI revealed that 94% were due to Escherica coli and 6% due to Citrobacter, Enterobacter, Klebsiella, and Proteus. Prescription practice differed although most providers did not document rationales for their selected antibiotic or presence/absence of culture. Most frequent prescriptions included Trimethoprim-sulfamethoxazole 160/180 mg BID for 3-7 days, Ciprofloxacin 100 mg BID for 3 days, and Nitrofurantoin 100 mg TID for 3-7 days. 52% received Trimethoprim-sulfamethoxazole which was sensitive to the microorganism, 33% were prescribed another drug when cultures documented sensitivity to Trimethoprim-sulfamethoxazole, and 15 % received Trimethoprim-sulfamethoxazole with culture identifying resistance to it. 85% of the patients could have effectively used Trimethoprim-sulfamethoxazole and with significant cost savings. Implications - A UTI protocol was developed which includes examination, culture, Trimethoprim-sulfamethoxazole 160/180 mg BID for 7 days, Pyridium 100 mg TID for 2 days, and evaluation of culture results and patient symptoms as follow-up. Alternative protocols are available for patients with allergy and demographics which correlate with antibiotic resistance. Patient outcomes, provider compliance, and cost effectiveness have generated positive results.
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