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Urinary Tract Infection Case 1

Step 1: Define the patient's problem


Diagnosis of asymptomatic UTI in pregnancy:

● Presence of bacteria in the urine without signs and symptoms of UTI (dysuria,
frequency, urgency)
● 2 consecutive voided urine specimens with the same organism in quantitative counts
≥100,000 CFU/mL
Case: Two urine cultures >100,000 CFU of both E. coli

Diagnosis: Asymptomatic bacteriuria in pregnancy

Step 2: State the therapeutic objectives


● To decrease bacterial load
● To prevent progression to symptomatic bacteriuria
● To prevent recurrence of UTI
● To prevent adverse pregnancy outcomes
● To prevent adverse drug reactions
● To prevent antibiotic resistance

Step 3: Choosing the P-drug class

Efficacy Safety Suitability Cost Total

1st gen +++ +++ ++ +++ 11


Cephalosporins Resistance
to E. coli
4%

2nd gen ++++ +++ ++ ++ 11


Cephalosporins Cefuroxime taken 2- 626 php
resistance 3x/day for 7
to E. coli days
37%

Aminopenicillin ++ +++ +++ +++ 11


High Safe for
resistance pregnancy
to E. coli
(83%)

Fosfomycin ++++ +++ +++ ++++ 14


Headache Single dosing 440php
Dizziness only,
Vaginitis unpalatable
Dysmenorrhe taste
a (<2% of
patients)

Nitrofurantoin ++++ ++ + + 9
Least Hemolytic Dosing 1067 php
resistance anemia regimen of 4
Anophthalmia times a day,
Hypoplastic bitter taste
left heart
syndrome,
ASD
Cleft lip and
palate
Given from
2nd trimester
to 32 weeks
AOG

BLIC ++ ++ +++ +++ 10


Resistance Up to 34%
to E. coli ADR of
27% diarrhea
Necrotizing
enterocolitis if
near preterm
labor

Cotrimoxazole ++ ++ +++ +++ 10


Resistance Teratogenic
to E. coli (1st trimester)
60% Kernicterus
(3rd
trimester)

Drug of choice: Fosfomycin

Step 4: Writing the prescription

Step 5: Give patient instructions and warnings


Explain to the patient the need for antibiotics despite being asymptomatic. There is a risk for
preterm labor and low birth weight of the baby or progression to symptomatic bacteriuria.
Advise the patient regarding possible side-effects such as headache, dizziness, vaginitis,
dysmenorrhea (<2% of patients)

Step 6: Monitor and follow up


Obtain Urine GS/CS 3 days after intake of Fosfomycin. Follow up after one week with GS/CS
results