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Dr. Throm is an assistant professor of pharmacy practice at Midwestern University College of Pharmacy?Glendale, Glendale, Arizona.
The uncomplicated, symptomatic lower urinary tract infection (UTI; acute bacterial cystitis) is a common and costly reason for physician referral and hospital visits. In the year 2000, 8.27 million physician visits for UTIs were reported (1.41 million men, 6.86 million women), with an estimated cost of $3.5 billion for evaluation and treatment.1 UTIs are more prevalent in women; of the 429,000 hospital stays due to UTIs, approximately 75% are attributed to women.1
The most common causative pathogen in uncomplicated, symptomatic lower UTIs is Escherichia coli, which accounts for 75% to 90% of infections. Staphylococcus saprophyticus follows, causing 5% to 15% of UTIs. The remaining infections are caused by enterococci, Klebsiella species, and Proteus mirabilis.2,3
The bladder is the most common site of lower UTIs. Common signs and symptoms of acute, uncomplicated lower UTIs in nonpregnant women include dysuria, frequency, or urgency. 2-4 Urine also may appear dark, cloudy, or pinktinged. Acute cystitis is more common in young, sexually active women with a history of UTIs.2,3 Complicated upper UTIs (eg, pyelonephritis) occur in the kidneys, are associated with systemic symptoms (eg, patients with fever, chills, flank pain), and are found more often in high-risk populations (eg, patients with diabetes, pregnancy, immunosuppression, previous pyelonephritis, symptoms lasting >14 days, or structural abnormalities of the urinary tract).2,3
Pharmacist?s Role in the Management of Acute, Uncomplicated UTIs in Women
Guidelines from the Infectious Diseases Society of America suggest the following empiric pharmacotherapy and recommendations for the treatment of uncomplicated UTIs in women4:
UTI symptoms typically subside within 1 to 3 days after antimicrobial therapy is initiated.2 Some patients with severe dysuria may be initiated on the urinary analgesic phenazopyridine (Pyridium or Uristat) for 1 to 2 days.2
Uncomplicated UTIs are common, and although the rate of TMP-SMX? resistant E coli is increasing, TMP-SMX is still a feasible first-line antibiotic.5 The pharmacist plays an important role in antimicrobial management in the patient with an acute, uncomplicated UTI. PT
UTIs = urinary tract nfections; bid = twice daily; N = nausea; V = vomiting; HA = headache; D = diarrhea. Adapted from references 2-4.