By- LAW JIA JUIN and His study member (with references)
In our topics we are discussing on pathophysiology of Urinary tract infection and the role of pharmacists on AK UTI treatment..
In the boundaries of pathophysiology of urinary tract infection, the route of infection of urinary tract should be discovered. In UTI microorganism such as E.Coli can enter the urinary tract through ascending and hematogenous (descending)1. Female urethra is usually colonized by bacteria from fecal flora. In the ascending pathway, the bacteria can enter the urethra during sexual intercourse.1 Once bacterial reached the bladder, the microorganisms multiply rapidly1. Then , the microorganisms ascend to the ureters and into the kidneys1.
On the other hand, organisms from a distant away from urinary tract that disseminate the urinary tract is known as descending pathway infection1. This is an uncommon infection1. The microorganisms that may cause this type of infection are Straphylococcus aureus , Candida spp, mycobacterium tuberculosis, salmonella spp, and enterococci1.
In a normal physiology,urinary tract is resistant to invasion by bacteria1 .For example,urine is able to kill bacteria. Low pH ,extremes in osmolality, high urea concentration, and high organic acid concentration are the factors that responsible to kill microorganisms1.But if these factors are disrupted, infection tends to occur.
Besides that, epithelial cell of the bladder is coated with glycosaminoglycan ,a thin layer of mucopolysaccharide1. This layer acts as a protective layer that prevent the bacteria from adhering on the bladder wall1. But when this layer is damaged under certain condition infection will occur also.
Tamm-Horsfall protein which is glycoprotein containing mannose residues produced by ascending limb of Henle and distal tubule are secreted into urine1. E.Coli that adhere to this glycolipid component are able to be washed out from the bladder by urination1. But in complicated urinary tract infection such as pyelonephritis, there is bacteria which has P type fimbriae that bind specificly to certain glycolipid receptor on uroepithelial so they are failed to be washout1. Thus, invasion is not prevented.
Pharmacy is the art and science of manufacturing, compounding, standardizing and dispensing of drugs2. Pharmacists also play a role in counseling our clients, so that they are educated in the particular medication.
Pharmacist should counsel their patients on medication prescribed or dispensed .We should give them a positive perspective towards their medication so that they will be more confident to their medication and adhere to it3.Since AK is given a treatment of Amoxicilin we can stress that this drug is a fairy broad spectrum antibiotic which can be used to treat infection from majority of susceptible bacterial species 4. And it is a good oral drug ,having high bioavailability when taken orally4.. We also counsel the patient on how to use the drug, in this case we need to tell them the oral dosage prescribed per day and the number of medication per day. For AK it is 3 times/day with 250mg every 8hours5 in AK case. We should also remind AK to take this antibiotic until finish although the symptoms of UTI are relieved5. If the mechanism of drug action is asked by AK, we can tell her that the lactam drug here cured by slowing down the growth and reproduction of bacterial not by killing them.
Counselling on common side effects of drugs is also needed We should tell AK that the side effects are hyperactivity,insomnia, dizziness5. But, at the same time we should tell her not to be too worry because not all serious side effects will happen. We should give our patients some tips on how to deal with the side effects Example we can ask AK to take a rest and stop driving for a while when dizziness happens during driving or working time. We also check for the allergic and family history of patients ,for example if AK is sensitive towards penicillin then we should consult the physician or her to use other antibiotic5. We should also advise the patients to come back to doctor if the symptoms proceed or serious side effect occur for example allergic or excessive diarrhea happens5.
Lastly, we also counsel patients on the non -pharmacological treatments and the way to prevent the reoccurrence of the diseases. For example we can encourage AK to drink crane berry juice and others herbs which are helpful in eliminating their bacterial5. We also remind AK to live a hygience and healthy lifestyle, for example wash her genital area every time before and after sexual activity with husband and ask her to drink more water and do not hold the urine for too long 5.In AK case we also suggest the combination treatment of amoxicillin with other antibiotic like enrofloxacin and clavulanic acid, for better efficacy of medication.
In conclusion, UTI happens when the natural defensive barriers of our urinary tract are disrupted or weaken and the pathophysiology of UTI can be classified into descending or ascending, as well as complicated and uncomplicated. As a pharmacist we ensure the best medication reaches the right individual.
References
<!--[if !supportLists]-->1. <!--[endif]-->Barbara G . Wells Joseph T .Dipiro Schwinghammer Cecily V . C.Yee Gary Pharmacotherapy A Pathophysiologic Approach .Seventh edition. United Kingdom : C hurchhill Livingstone Elsevier; 2008. p. 1900-1901
<!--[if !supportLists]-->2. <!--[endif]-->Sheba.D.Introduction to General Pharmacology<internet>.2011[updated on 2011 jan; cited on 2011 july 23].Available link: http//:elearning.imu.edu.my
<!--[if !supportLists]-->3. <!--[endif]-->Positive Thinking Technique.<internet>2010[updated2010;cited 2011 july 24]available link from:hubpages.com
<!--[if !supportLists]-->4. <!--[endif]-->Amoxicilin.<internet>2010[updated on 2011 july 11; cited on 2011 july 23].Available link http//:enwikipedia.org/wiki/amoxicillin.
5. Omudhume ogbru.pharm D.MedicineNet.Amoxicilin<Internet>[updated on 2011 july 24;cited on 2011 
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