1.

Summary of event

- Chief complaint

“I have been urinating frequently along with urgency as well as having discomfort when urinating.”

- Reason for pharmacy/hospital visit

The patient was experiencing these symptoms for 2 days and over the next 12 hours or so, these symptoms persists, and
she noticed her urine is pink or bloody. She became concerned and went to visit the hospital.

2. Patient Profile

A 20-year-old female student

She has no previous history of similar complaints. However, she has recently became sexually active and has been using
a diaphragm with spermicide.

Her vital signs are: T = 37.5ºC, HR= 105 beats per minute, R = 18 breaths per minute, and BP = 105/70 mm Hg.

- Past medical history

No significant past medical history.

- Medications taken

None.

- Allergies

No known allergies.

3. Diagnosis

The only abnormal finding on physical examination is a mild tenderness to deep palpation in the suprapubic area. No genital
ulcers are noted. There is no vaginal discharge.

The patient's history might indicate a sexually transmitted disease. However, she does not have any signs or symptoms
(i.e., genital lesions or purulent discharge) that might specifically point to one of the common STDs. The primary symptoms
of dysuria, frequency, and urgency would appear to indicate a UTI. In the absence of significant fever and flank pain (which
might indicate pyelonephritis), it is most likely cystitis (inflammation of the bladder), a lower UTI.

To confirm the diagnosis, the patient underwent a urinalysis with microscopic evaluation of clean-catch urine for bacteria
and pyuria. The urine sediment contained innumerable white blood cells, moderate numbers of red blood cells, and
noticeable bacteria.

The lab tests confirmed a diagnosis of acute uncomplicated cystitis.

4. Pharmacist Intervention

- Medication Dispensed and Action

The medication dispensed was Trimethoprim/Sulfamethoxazole 160/800mg (Bactrim DS) considering the cost, availability,
and tolerance.

- Dosage Regimen

Trimethoprim/Sulfamethoxazole (Bactrim DS; 160/800 mg twice per day for three days)

5. Patient Counselling by Pharmacist

- Disease

Cystitis is an infection in your bladder that is caused by bacteria. If you have a bladder infection, you may feel pain when
you urinate or have an unusually strong need to urinate. You may also urinate more often and have pain in your lower
stomach.
Bladder infection usually happens in healthy women of reproductive age. It is normal to have bacteria that live around your
urethra, which is where urine comes out. These bacteria usually are not harmful. However, sometimes they can get into
your bladder. You may be more likely to get a bladder infection if you hold your urine for a long time, if you have sex often,
or if you are pregnant.

- Medication

This medication is a combination of two antibiotics, sulfamethoxazole and trimethoprim. It is indicated in the treatment
of acute uncomplicated cystitis. This medication treats only certain types of bacterial infections and will not work for viral
infections, such as flu. Unnecessary use or misuse of any antibiotic can lead to its decreased effectiveness. In addition,
common adverse effects are nausea, vomiting, and anorexia, as well as skin reactions including rash, urticaria, and
photosensitivity. If a rash appears, treatment should be discontinued immediately due to the risk of severe allergic reactions.

- Administration

Take this medication by mouth, as directed by your doctor, with a full glass of water (8 ounces). If stomach upset occurs,
take with food or milk. Drink plenty of fluids while taking this medication to lower the unlikely risk of kidney stones forming,
unless your doctor advises you otherwise. For the best effect, take this antibiotic at evenly spaced times. To help you
remember, take this medication at the same time(s) every day. Continue taking this medication until the full prescribed
amount is finished, even if symptoms disappear after a few days. Stopping it too early may allow bacteria to continue to
grow, which may result in a relapse of the infection. Tell your doctor if your condition persists or worsens.

6. Frequently Asked Questions about the disease & medication

What predisposing factors for this type of infection?

Women are generally far more susceptible than men to lower UTIs for several reasons. The female urethra appears to be
particularly prone to colonization because of its proximity to the anus. The comparatively short length of the female urethra
also facilitates transport of bacteria from the periurethral area to the bladder. The incidence of UTIs in young women
increases markedly with the onset of sexual activity. Apparently, sexual intercourse mechanically introduces urethra
associated bacteria upward into the bladder. As a result, voiding shortly after intercourse helps to reduce the risk of cystitis.
The use of a contraceptive diaphragm interferes with complete emptying of the bladder. Urine retained in the bladder
encourages the growth of bacteria therein and greatly promotes infection.

What if I missed a dose?

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your
next dose at the regular time. Do not double the dose to catch up.

Can I take an over-the-counter pain medication and drink cranberry juice or cranberry tablet?

You can also take over-the-counter pain medicine. On the other hand, drinking cranberry juice and taking cranberry tablets
have not been shown to help.

When will I begin feeling better?

Many women begin feeling better within 36 hours of starting an antibiotic.

7. Alternative Medications/Actions

Fluoroquinolones (i.e., ofloxacin, ciprofloxacin, and levofloxacin) are considered second-tier antimicrobials. Although
fluoroquinolones are effective, they have the propensity for collateral damage, and should be considered for patients with
more serious infections than acute uncomplicated cystitis. Certain antimicrobials (i.e., beta-lactam antibiotics,
amoxicillin/clavulanate, cefdinir, cefaclor, and cefpodoxime) may be appropriate alternatives if recommended agents cannot
be used because of known resistance or patient intolerance.

Furthermore, various behavioral strategies to prevent recurrence of cystitis such as reducing the frequency of sexual
intercourse, avoiding spermicides and condoms with spermicides that would alter the vaginal flora, and urinating as soon
as possible after sexual intercourse and drinking plenty of fluids are helpful.
Week 2: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3501915/

Week 3: https://pdfs.semanticscholar.org/bc8d/20bfeb9e96a83132ba23ccfeb372386b4390.pdf

Week 4: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3598222/

https://www.mdedge.com/clinicianreviews/article/72153/endocrinology/prolactinoma-case-study