Shadow Health For UTI And Antibiotic Sensitivity Paper
Shadow Health For UTI And Antibiotic Sensitivity Paper
This assignment is a focused exam with a patient who presents with a UTI and antibiotic sensitivity. You will conduct an interview Makayla Henderson using therapeutic communication to determine the appropriate pharmacological therapy for her condition. After the exam, you will select the most appropriate medication for Ms. Henderson and educate her on her medication and disease management. If applicable, you will write a prescription for the selected medication.
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Antibiotics such as fosfomycin and nitrofurantoin, in this study show a good sensitivity profile in the isolates of the urine cultures analyzed, suggesting that they are a good option for the empiric treatment of uncomplicated low UTIs, since they are oral drugs without good Renal penetration. It was also shown that antibiotics such as quinolones had a high resistance profile throughout all analyzes. Shadow Health For UTI And Antibiotic Sensitivity Paper
Amikacin showed good sensitivity profile throughout all the results, as has been reported by other authors.9-13 dDespite this, the antibiotic would not be used as empirical therapy for uncomplicated UTIs, but for the management of a UTI where there is a multiresistance towards the other antibiotics that could cause fewer adverse events. The quinolones had high percentages of resistance, which is important, since some authors in Latin America report a high resistance to quinolones,9-12,14-15 while others, a good sensitivity,16 which leads to think that at the moment of a possible empirical therapy, the endemic profiles of each country should be taken into account. Shadow Health For UTI And Antibiotic Sensitivity Paper
Certain authors consider age as a factor of importance with respect to increased resistance. Resistance is proposed to increase in people older than 60 years compared to those of younger age, which is usually associated with the use of catheters and chronic diseases.17,18 It is clear that in the study there was an interesting difference between age groups and resistance percentages. As the age group was higher, the percentages of resistance were also slightly higher.
The antibiotic with the highest percentages of resistance throughout the study was TMP-SMX, which is in agreement with other studies in Latin America where resistance to TMP-SMX is frequent.11-16,19-21 However, it has also been reported in the region, some sensitivity to TMP-SMX in the urine cultures.9,22
It is important to mention that, over time, good sensitivity profiles for nitrofurantoin have been beginning to be reported, albeit with limited spectrum; This antibiotic has been referred by many authors with a sustained sensitivity above 70% and even 80%.3,10-12,14,20 In addition to this pattern, some authors outline a low resistance profile for nitrofurantoin.13,15-16 This provides an interesting profile at the time of selection as empirical therapy for the management of uncomplicated low UTIs, in order to obtain high referral rates. In the study it was evident that this antibiotic, throughout all the analysis groups, was always sensitive above 50%.Shadow Health For UTI And Antibiotic Sensitivity Paper
Despite the fact that due to the method used for the isolation of the bacteria, direct detection of strains possessing extended spectrum beta-lactamases (ESBL) or cAMP was not made, it is necessary to mention as the Enterobacteriaceae acquire resistance by the mentioned mentioned above, and somehow could be inferred if indeed they are strains with these characteristics. It is known that the Enterobacteriaceae positive for ESBL possess significant resistance to ampicillin, ampicillin-sulbactam, ceftriaxone, sulfamethoxazole trimethoprim and quinolones.9, 14- 17, 23 This is of paramount importance, since the study shows that most of the isolates had a significant resistance to the antibiotics mentioned above. Secondly, Enterobacteriaceae also demonstrate a significant phenotypic characteristic, such as beta-lactamase cAmp, which confers significant resistance to third-generation cephalosporins.17,13
It would be advisable to carry out more observational studies in all the zones of the country, in order to promote the development of a local guide directed to the ambulatory management of the urinary infections of a staggered form, based on the resistance patterns that have in the region, through comparative studies.
Padgett, et al., in the Hospital of Specialties of the Honduran Institute of Social Security, reported the evolution of resistance of E. Coli from 2006 to 2009, through the committee of prevention and control of nosocomial infections. There was a slight decrease in resistance to ciprofloxacin from 42% to 35%, and ceftriaxone from 47% to 31%.24
The development of epidemiological and pharmacological surveillance programs would provide a powerful tool to reduce levels of antibiotic resistance related to causes such as underdosing, inappropriate use of antibiotics, among others. It is proposed to develop local prospective studies to determine which antibiotics would be most useful on a regional basis. The results encourage more complex studies, determine that there are actually better treatment options and have a good therapeutic escalation regarding patient management.
One of the limitations of the study was that the sensitivity disks were not the same in all laboratories. We did not obtain the addresses of the patient’s places of origin, which would have provided breadth with respect to which areas have a higher prevalence of certain bacteria or antibiotic resistance in the metropolitan area, to determine the heterogeneity of this area.
Funds: The financing of the study belonged to each participant researcher, for which it was stated that there was no conflict of interest.
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Acknowledgments: to the reviewers of this article: Bárbara Bribiesca, MD, Monique Baudrit, MD and Daniel Bustos, MD; to those who provided results of urine cultures; to the laboratories Fiallos, Bueso Arias, UDE, Del Valle Hospital, Bendaña Hospital and Clinical Diagnostic Center, of the cities of San Pedro Sula and El Progreso, Honduras. For their logistical support to carry out the study and the data collection, the collegues Ángel Martínez, Eylin Urbina, Eduardo Borjas, María Elena Chavarría, Heidy Fúnez, Osman Fuentes, Dilcia Lagos, Rocío Lagos, Fernando Paz, María Mandujano, Shirley Baiza and Saúl Paz. Shadow Health For UTI And Antibiotic Sensitivity Paper