Urinary Tract Infections: Treatment and Prevention

This assignment explores the topic of urinary tract infections (UTIs). It delves into the various aspects of UTIs, including their causes, risk factors, diagnostic procedures, treatment options (antibiotics like amoxicillin trihydrate), and strategies for prevention. The document emphasizes the importance of adherence to clinical guidelines for UTI management and highlights the role of cranberry products in preventing these infections.

Running head: LOWER URINARY TRACT INFECTION
LOWER URINARY TRACT INFECTION
Name of the Student
Name of the University
Author Notes

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Executive Summary
This report is the case study of Queenie Jacobs, who had been admitted to the hospital with
symptoms of confusion, dehydration and fever. Further examination revealed that she was
suffering from lower urinary tract infection. The causative organism was Escherichia coli and it
was found to be sensitive to co-amoxiclav. Because of her dehydration she was treated with
intravenous fluids and Trimethoprim initially, then given oral administrations of co-amoxiclav.
This report provides the pathophysiology of the disease along with the symptoms, risk factors,
complications and the necessary nursing care plan. The report also provides the pharmacology of
the medication along with medication management standards.

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Table of Contents
Lower urinary tract infection...........................................................................................................4
Pathophysiology of lower urinary tract infection............................................................................5
Signs and symptoms........................................................................................................................6
Association of E. coli with urinary tract infections.........................................................................6
Complications of urinary tract infections........................................................................................8
Nursing care for urinary tract infections..........................................................................................8
Pharmacodynamic and pharmacokinetic principles of Co-amoxiclav..........................................10
Side effects of the drug..................................................................................................................13
Antibiotic Resistance.....................................................................................................................14
Medication management................................................................................................................14
Conclusion.....................................................................................................................................15
Reference List................................................................................................................................17

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Introduction
Lower urinary tract infections are found to be common among women, particularly the
post-menopausal women (Al-Badr and Al-Shaikh 2013). This is the most common form of
bacterial infection that occur among women (Hotchandani and Aggarwal 2012). Lower urinary
tract infections among women can be classified based on the age of the women (Tan and
Chlebicki 2016). These include the pre-menopausal women, healthy post-menopausal women of
the age group between 50-70 years old and the institutionalized post-menopausal elderly women
(Mody and Juthani-Mehta 2014). Most of the elderly women with lower urinary tract infections
remain asymptomatic, however, some suffer from symptoms like incontinence, frequent
urination, discomfort during urine discharge (Komala and Kumar 2013). Post-menopausal
women are particularly prone to this problem. This can be due to the fact that the levels of the
hormone estrogen declines under such conditions, which predisposes them to contracting such
infections (Robinson, Toozs-Hobson and Cardozo 2013).
This report is based on the case study of Queenie Jacobs, who is a 73-year-old women.
She got admitted to the hospital after showings signs of dehydration, confusion and fever.
According to her husband, she had been showing signs of frequent urination and a burning
sensation during urine discharge. Dipstick analysis was done to determine the presence of
leukocyte esterase and nitrate (Mambatta et al. 2015). Mid-stream urinalysis report revealed that
she was positive for leukocyte esterase and nitrate. Further microscopy, culture and sensitivity
tests revealed the presence of Escherichia coli infection, which is sensitive to co-amoxiclav.
Management of urinary tract infections is complicated due to the presence of antibiotic
resistance. Trimethoprim and sulfamethoxazole are the 2 antibiotics, which are prescribed for
urinary tract infections. However, E. coli strains have been found that are resistant to these

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antibiotics (Guneysel, Suman and Cimilli Ozturk 2016). In this case study, the resultant E. coli
strain being Trimethoprim resistant was administered with co-amoxiclav.
This report will provide a brief description of the lower urinary tract infections, risk
factors of the patient in the case study, pathophysiology of the infection; role of E. coli in the
infection occurrence, signs and symptoms of the disease, complications associated with the
infection, the necessary nursing care and pharmacological description of the administered
medication.
Lower urinary tract infection
Urinary tract infections are localized to the urinary tract. Lower urinary tract infections
are also called cystitis (Barber et al. 2013). The lower urinary tract infections can be either
symptomatic or asymptomatic. Presence of bacteria in the urine but without the presence of
symptoms are termed as asymptomatic bacteriuria (Cai et al. 2012). Symptomatic infections are
associated with frequent urination, problems during urine discharge and incontinence (Mody and
Juthani-Mehta 2014). Lower urinary tract infections are common among pre as well as post-
menopausal women. E. coli is the most common cause of lower urinary tract infections (Flores-
Mireles et al. 2015). There are various causes that can give rise to lower urinary tract infections
among both men and women. Sexually active and post-menopausal women are highly prone to
contracting urinary tract infections (Cai et al. 2012). Among men, presence of chronic prostatitis
can give rise to lower urinary tract infection (Zhao et al. 2012). Urinary catheterization is also
another risk factor that pre-disposes an individual to lower urinary tract infections. Moreover,
diabetes can also predispose an individual to developing lower urinary tract infections. In
children, constipation and vesicoureteral reflux is associated with the development of lower

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urinary tract infections (Foxman 2014). The patient described in this case study is a 73-year old
female. She is healthy but is post-menopausal. So, her lower urinary tract infection falls under
the classification involving healthy post-menopausal women, who are not hospitalized or use
catheters. Estrogen deficiency plays an important role in the development of lower urinary tract
infections among post-menopausal women (Kim et al. 2015). Reduction in estrogen levels is
associated with vaginal atrophy. It is associated with symptoms like vaginal dryness,
dyspareyunia, itching and incontinence. Estrogen also helps to maintain the normal vaginal flora
that maintains the acidic pH and prevents colonization of pathogens that cause urinary tract
infections (Goldstein et al. 2013). Thus, in this case study, the patient being post-menopausal
have resulted in her developing the urinary tract infection.
Pathophysiology of lower urinary tract infection
Urinary tract infections can be symptomatic and asymptomatic. Symptomatic bactertial
infections involve infections of the lower urinary tract also called cystitis and infection of the
upper urinary tract also called acute pyelonephritis. Asymptomatic urinary tract infections results
when urine cultures have greater than 100,000 colony forming units per ml of urine with absence
of symptoms (Fünfstück et al. 2012). Urinary tract infections are considered to be complicated
when there are presence of symptoms of pyelonephritis. Moreover, urinary tract infections are
considered to be complicated if found in immunosuppressed individuals, diabetics, pregnant
women, men or individuals with urinary tract structural abnormalities (Mnif et al. 2013; Hooton
2012). E. coli is most commonly associated with these infections. The first step in the
development of the infection by the pathogen is periurethral colonization. This is followed by
attachment and subsequent penetration of the bladder epithelium. Penetration is followed by
bacterial replication and the formation of biofilms. Bacterilal colonization is followed by

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ascension process and bacterial toxins play an important role in inhibiting peristalsis. This is
followed by infection of the renal parenchyma, which results in pyelonephritis (Smee 2012).
Further inflammation and tubular obstruction results in interstitial edema leading to interstitial
nephritis and acute kidney injury. Risk factors can be classified into latrogenic (use of catheters)
or drugs (decrease the normal bacterial flora), behavioral (voiding dysfunction, sexual activity),
anatomic or physiologic (Vesicoureteral reflux, pregnancy, menopause) and genetic (properties
of the vaginal mucus, susceptibility of the uroepithelial cells and familial tendency) (Al-Badr and
Al-Shaikh 2013; Flores-Mireles et al. 2015; Nicolle 2014).
Signs and symptoms
The symptoms include Dysuria, increased urgency and frequency associated with
urination, hematuria, suprapubic tenderness, fever and flank pain (Ncbi.nlm.nih.gov 2018).
Overactive bladder is the most important and defining symptom associated with lower urinary
tract infections. Urgency is a pathological symptom resulting in nocturia, decreased intervoid
interval, incontinence and decrease in urinary volume (Rowe and Juthani-Mehta 2014). The
patient described in this case study also shows symptoms of dysuria, overactive bladder,
increased urgency and frequent urination, as well as pyrexia or fever.
Association of E. coli with urinary tract infections
Uropathogenic E. coli are generally the causative agents of lower urinary tract infections.
The expression of virulence factors helps the pathogen to evade the host defences and colonize
the urinary tract thereby giving rise to infections. The virulence factors that are important and are
associated with the development of urinary tract infections are the adhesins, hemolysin, K
capsule, aerobactin system, resistance to serum killing, among others. The adhesins include P

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fimbriae, type 1 fimbriae and mannose resistant adhesins (Bien, Sokolova and Bozko 2012). The
surface virulence factors help in the attachment of the bacteria to the host tissues (Lewis,
Richards and Mulvey 2016). The adhesins function by activating the bacterial and host signaling
pathways, promoting bacterial invasion and helping in the delivery of bacterial virulence
products to host surfaces. The type 1 fimbriae functions by activating the signaling pathways that
facilitate invasion and subsequent apoptosis. P fimbriae plays an important role in ascending
urinary tract infections as well as pyelonephritis. The P fimbriae is responsible for mucosal
adhesion and cytokine production, thereby leading to pain and inflammation. Afimbrial Afa and
Dr adhesins are associated with recurring cystitis. The capsule (K1 and K5) provide protection
against engulfment by phagocytes and bactericidal effects of the complement system. They
prevent the development of the humoral immune response in the infected host cells (Kudinha et
al. 2013). The lipopolysaccharide also plays a vital role in the pathogenesis and development of
urinary tract infections. Among the secreted virulence factors, the most important is the α
hemolysin. This hemolysin is a pore-forming toxin that causes lysis of the nucleated host cells
and erythrocytes thereby enabling the pathogen to cross the mucosal barrier and damage the
effector immune cells of the host. Other virulence factors involve the cytotoxic necrotizing factor
1 and the secreted autotransporter toxin. The secreted autotransporter toxin functions as a
virulence factor in the case of E. coli involved in pyelonephritis. The cytotoxic necrotizing factor
is known to promote apoptosis of the bladder epithelial cells and helps to protect the bacteria
from the phagocytic activity of the neutrophils thereby protecting the bacteria from attacks by the
host defense system. Moreover, the O antigen protects the bacteria from serum killing by
activation of complement system distant from target sites present on the outer membrane or by
causing obstructions in the antibody binding sites (Welch 2016; Garcia et al 2013). Formation of

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biofilms helps to protect the bacteria from neutrophil migration and subsequent killing.
Moreover, biofilms make the bacteria resistant to antibiotics. Bacteria also forms biofilms on
foreign bodies like catheters and is the major cause of catheter related bacteriuria. E. coli also
consist of siderophores that help the bacteria to carry out iron uptake. This iron uptake system
enables E. coli to survive in the urinary tract. The iron scavenging system enables the E. coli to
overcome the iron limitation inside the host body (Subashchandrabose and Mobley 2015).
Complications of urinary tract infections
Some of the complications of urinary tract infections include kidney infection or
pyelonephritis, kidney failure, blood poisoning or sepsis. A kidney infection is associated with
fever, shivering, chills, and pain in the sides or the back. Recurrent urinary tract infections can
result in damage to the kidneys. This can give rise to kidney or renal failure. Sepsis is another
fatal complication associated with urinary tract infections. The bacteria spread from the kidneys
to the bloodstream and then spread to various parts of the body including the organs. Chronic
infection can give rise to abscesses, fistulas, urinary strictures, kidney stones, bladder cancer,
among others. Another complication in pregnant women is the delivery of premature or low birth
weight infants (Nhsdirect.wales.nhs.uk 2018). Urinary tract infection is also associated with
causing confusion among the elderly suffering from dementia. Elderly people with dementia can
suffer from heightened responses like agitation, confusion or withdrawal due to urinary tract
infections (Alzheimers.org.uk 2018). The elderly patient in this case study also suffered from
confusion, fever, chills, among others.

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Nursing care for urinary tract infections
The nursing diagnosis for urinary tract infections include impaired urinary elimination,
acute pain, infection, hyperthermia, disturbed sleep and deficient knowledge (Silva et al. 2017).
Impaired urine elimination is associated with dysuria, increased urine frequency, urgency or
hesitancy (Zatorski et al. 2016). The patient in this case study suffers from dysuria as well as
increased urine frequency and urgency. The desired nursing outcomes would be to achieve
normal patterns of urine elimination and absence of symptoms of dysuria like pain and
discomfort. The nursing interventions include assessment of the patient’s urine elimination
pattern, recording the client’s gender and age, palpating the patient’s bladder to determine if
urinary retention is present, promoting increased fluid uptake to increase the renal blood flow,
promoting frequent voiding in order to prevent urine accumulation, use of Mandelamine and
vitamin C in order to maintain an acidic pH in the bladder thereby preventing the growth of
bacteria (Lockwood 2017). The second nursing diagnosis is infection and is associated with
bacteriuria, burning sensation during urination, fatigue, fever, flank pain, offensive odor,
hematuria, suprapubic tenderness, increase in the number of white blood cells, increased urine
frequency, cognitive impairment in older adults, anorexia, among others (Cortes-Penfield,
Trautner and Jump 2017). The patient in the case study also suffers from bacteriuria, hematuria,
feels a burning sensation and discomfort during urine, has a bad odor in the urine and also shows
signs of confusion, which could be due to cognitive impairment. The nursing interventions
would be to assess the signs and symptoms as well as the risk factors, monitoring white blood
cell count, urinalysis, bacterial count, urine culture and antibiotic sensitivity (Doern and
Richardson 2016). Other nursing interventions would be to drink cranberry juice that prevents or
reduces the bacterial adherence, use of vitamin C, promote regular voiding, antibiotic therapy

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(Wang et al. 2012) The patient in the case study was also subjected to mid-stream urinalysis and
E. coli sensitivity to co-amoxiclav was determined. The third nursing diagnosis is acute pain that
is associated with burning sensation, decreased physical activity, spasms in the bladder and
lower back. The nursing interventions include assessment of the nature, severity and quality of
pain, use of therapies like massage, relaxation and guided imagery, increased fluid intake in
order to overcome dehydration, use of sitz baths, applying heating pad and use analgesics like
acetaminophen and antispasmodics like phenazopyridine (Poopola 2015; Gupta and Aggarwal
2012). The patient in the case study also suffers from dehydration. The nursing interventions for
disturbed patterns of sleep associated with nocturia and pain are promoting the use of warm
baths, back rubs, encouraging consumption of milk, limiting fluid intake at night and also intake
of caffeine containing beverages (Das and Grimmer-Somers 2012). Hyperthermia is associated
with increased body temperature; flushing and the necessary nursing interventions would be to
assess the body temperature, monitoring of vital signs, encouraging fluid intake and sponge
baths, use of hypothermia wraps, administration of anti-pyretic drugs, among others (Young and
Saxena 2014). The patient described in the case study also had high body temperature or pyrexia.
The nursing interventions regarding deficient knowledge of the patients would be to explain the
patient about the causes, risk factors and prevention measures. Educating the patient about the
use of hygienic measures, maintenance of perineal hygiene, frequent voiding, among others
(Nrsng.com 2018).
Pharmacodynamic and pharmacokinetic principles of Co-amoxiclav
The antibiotic co-amoxiclav consists of two types of antibiotics. These are amoxicillin
and clavulanic acid. Co-amoxiclav is used to treat a variety of infections like sinus, urinary tract,
skin or dental infections. It belongs to the Penicillin drug class. Amoxicillin is a beta lactam

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antibiotic that plays an important role in the inhibition of the enzymes like penicillin binding
proteins, thereby inhibiting the synthesis of peptidoglycan (Worthington and Melander 2013),
which is an important component of the cell wall of bacterial. Cell wall weakening results in cell
lysis, damage and eventual death (Contreras-Martel et al. 2017). Clavulanic acid is another beta
lactam antibiotic that prevents the inactivation of amoxicillin by inactivation of beta lactamase
enzymes (Shaikh et al. 2015). Clavulanic acid does not possess any significant antimicrobial
properties when used alone (Mhra.gov.uk 2018). The pharmacokinetic properties of co-
amoxiclav include absorption, distribution, biotransformation and elimination. Both amoxicillin
and clavulanic acid undergoes full disassociation under physiological pH in aqueous solutions
(Thambavita et al. 2017). They are readily absorbed by the oral administration route. Optimum
absorption of amoxicillin and clavulanic acid occurs, when taken before meals
(Dailymed.nlm.nih.gov 2018). Following absorption, 18% of the total plasma amoxicillin
remains bound to proteins while 25% of total plasma clavulanic acid remains bound to proteins
(De Cock et al. 2015). Amoxicillin provides an advantage with regards to other beta lactam
antibiotics as it has a greater oral bio-availability. The distribution volume is 0.3-0.4l/kg in case
of amoxicillin and 0.2l/kg in case of clavulanic acid. Intravenous administration of amoxicillin
and clavulanic acid results in their accumulation or distribution in the gall bladder, skin, fat,
synovial or peritoneal fluids, bile, muscle tissue (Medsafe.gov.nz 2018), among others. They are
also known to cross the placental barrier (Medicines.org.uk 2018). Amoxicillin undergoes
biotransformation to inactive penicilloic acid and gets excreted in the urine. Clavulanic acid also
undergoes extensive metabolism and gets excreted along with urine and stools (Mhra.gov.uk
2018). Moreover, it can also be excreted in the form of carbon dioxide in air (Medicines.org.uk
2018). The main route of elimination is the kidney in case of amoxicillin, while clavulanic acid

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can get eliminated via renal as well as non renal mechanisms (Medsafe.gov.nz 2018). Following
24 hours of administration of the drug, 50-85% of amoxicillin gets excreted through the urine,
while 27-60% of clavulanic acid gets eliminated through urine (Medicines.org.uk 2018).
The dosage of co-amoxiclav selected depends on the pathogen and their susceptibility,
the site of the infection and the severity of the disease. Moreover, the dosage also depends on the
patient’s age, weight and renal function. Urinary tract infection in the case of children is
generally provided with Trimethoprim for 5-7 days. Complicated urinary tract infections or
pyelonephritis is associated with various factors like pregnancy, diabetes mellitus, renal
abnormalities, catheterization, recurring symptoms and use of broad spectrum antibiotics. The
dosage of co-amoxiclav in case of such situations is an oral dose of 625mg on an 8 hourly basis
along with an intravenous administration of 7mg/kg/day of gentamicin. The treatment duration is
generally 7-14 days (Wwl.nhs.uk 2018). The patient in the case study had been previously
administered with a broad spectrum antibiotic Trimethoprim and as a result, she was provided
with co-amoxiclav on an 8 hourly basis for 4 days. However, 250mg/125mg of co-amoxiclav
tablets are recommended for both children and adults suffering from urinary tract infections. In
the case of urinary tract infections 250mg/125mg of co-amoxiclav tablets is given for cystitis and
pyelonephritis. The usual dose is 3 times daily. Co-amoxiclav can also be given intravenously.
Co-amoxiclav is used in the treatment of infections concerning beta lactamase producing
coliforms (Durojaiye and Healy 2015).
Before initiating therapy with co-amoxiclav, nurses are required to enquire about any
previous hypersentivity reactions of the patients with respect to penicillins or other beta lactam
antibiotics. In the cases of allergic reactions, administration of co-amoxiclav are required to be
discontinued. Alternative treatment is with Trimethoprim, oral administration of 200mg on a 12

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hourly basis and the duration of treatment should be for 10 days (Wwl.nhs.uk 2018). Nurses are
also required to monitor the number of doses and should assess the patients with renal
impairments. Convulsions are observed in patients, who have received high doses or have renal
impairment. In the case of infectious mononucleosis observed as a morbiliform rash, the use of
co-amoxiclav should be avoided. Thus, nurses are required to monitor the presence of such a
rash in patients treated with amoxicillin. The occurrence of symptoms of acute generalized
exanthemous pustulosis after initiation of treatment should be noted by the nurses and should be
discontinued. Nurses should administer co-amoxiclav with caution in patients suffering from
hepatic impairment. Monitoring of the patients showing signs of diarrhea after administration of
the antibiotic indicates the development of antibiotic associated colitis (Darouiche and Hull
2012). In this case also the use of the antibiotic should be discontinued. During prolonged
therapy, nurses are required to carry out periodic assessments of renal, hepatic and hematopoietic
functions. During administration of the antibiotic, the nurses are required to maintain a balance
between the intake of adequate fluid and urine output. This will help prevent the development of
amoxicillin crystalluria. Monitoring of glucose in urine is to carried out by glucose oxidase
methods. The nurse’s role when treating elderly patients with co-amoxiclav is to monitor renal
function. Appropriate monitoring is also required in cases where anti-coagulants are given along
with the medication. Monitoring of hepatic functions is also essential in the case of patients with
hepatic impairment. The nurses are also required to assess, monitor and report any symptoms of
side effects associated with the drug (Medicines.org.uk 2018).
Side effects of the drug
The side-effects include allergic reactions like vasculitis, fever, joint pain, swollen
glands, angioedema, collapse, Stevens-Johnson syndrome, erythema multiforme, toxic epidermal

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necrolysis, bullous exfoliative dermatitis and exanthemous pustulosis. Other side effects include
inflammation of large intestine, hepatitis, jaundice, convulsions, diarrhea, thrush, nausea,
vomiting, among others (Medicines.org.uk 2018).
Antibiotic Resistance
Antibiotic resistance is common in the case of urinary tract infections. According to the
NHS, analysis of urinary tract infection samples indicates the presence of antibiotic resistant
bacteria and approximately 34% of the samples are found to be resistant to trimethoprim.
Trimethoprim was initially the choice of treatment with respect to urinary tract infections, but
public health England has recommended a different antibiotic named nitrofurantoin due to the
resistance to trimethoprim (Nice.org.uk 2018). Extended beta lactamase producing strains of E.
coli are a growing concern due to their resistance to penicillins, cephalosporins, trimethoprim,
fluoroquinolones, among others. Resistance to trimethoprim has been on the rise particularly in
the United Kingdom with respect to urinary tract infections in children. Amoxicillin along with
clavulanic acid is given to treat beta lactamase producing coliform bacteria (Ramlakhan et al.
2014). In this case study also the patient was given co-amoxiclav due to resistance to
trimethoprim.
Medication management
The NMC standards that are applicable for this case study are the following: Standard 1
that deals with the methods of administration. The nurses are required to look into the medicine
administration chart before administration. Standard 2 that deals with checking. While
administering the drug, the nurses are required to check prescriptions on whether the patient is
allergic to the drug or not. The drug administration should also be associated with informed

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consent from the patient and the patient should be aware of the treatment. Moreover, it is also
necessary for the nurse to identify the patient for whom the desired medication administration is
intended. Standard 4 deals with prescription medicines. The nurse’s are required to provide the
appropriate medication against a written prescription to the patients so that they can safely self-
administer or can be administered by another professional. The standard 8 describes the role of
administration. The nurse’s role is to be carry out her duty that is associated with favorable
outcomes for the patient. The nurse should have information about the identity of the patient to
whom the drug is to be administered. Moreover, before administration it is also necessary for the
nurses to determine whether the patient is allergic to the drug or not. The nurses should also have
information about the plan of care of the patient. According to standard 9, the nurse’s are
responsible for continuous assessment of the patient who are carrying out self-administration of
the drug. The nurse should recognize the symptoms of the patients after drug administration and
bring about necessary changes. According to standard 10, nurse’s are required to ensure during
discharge of the patient that the patients are aware of the administration of the drug. According
to standard 17, the nurse’s are responsible for the delegation of the medications and also to
ensure that the patient or carer are competent to carry out the task. According to standards 24 and
25, nurse’s are required to manage and report any adverse reactions arising as a result of the
drug. During discharge, the nurse’s are required to determine whether the medications provided
to the patient is in accordance with the prescription (Nmc.org.uk 2018). In the case study, also
the patient had been provided with the details of the drug administration prior to discharge.
Conclusion
The report is a case study of an individual who had been diagnosed with lower urinary
tract infection. Further investigations revealed that the cause was E. coli that was sensitive to co-

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amoxiclav. She was administered with co-amoxiclav orally. This report provides a brief
description of lower urinary tract infections followed by a description of the pathophysiology,
risk factors, signs and symptoms as well as complications associated with the disease. The signs
and symptoms associated with urinary tract infections include Dysuria, increased urgency and
frequency associated with urination, hematuria, suprapubic tenderness, fever and flank pain. An
appropriate nursing care plan is also essential for management of the patient symptoms. In this
case study, the patient being an elderly female is post-menopausal and as a result, she had
become prone to the infection. She also showed signs of dysuria as well as a burning sensation
and discomfort. Due to the presence of trimethoprim resistance she was provided with co-
amoxiclav. The report also provides information about the pharmacology and pharmacokinetic
principles of the drug co-amoxiclav. Some of the side effects of the drug co-amoxiclav includes
vasculitis, fever, joint pain, swollen glands, angioedema, collapse, Stevens-Johnson syndrome,
erythema multiforme, toxic epidermal necrolysis, bullous exfoliative dermatitis and exanthemous
pustulosis. Finally, the standards of nursing practices ensure safe and effective care delivery to
patients.

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Reference List
Al-Badr, A. and Al-Shaikh, G., 2013. Recurrent urinary tract infections management in women:
a review. Sultan Qaboos University Medical Journal, 13(3), p.359.
Alzheimers.org.uk (2018). Cite a Website - Cite This For Me. [online] Alzheimers.org.uk.
Available at:
https://www.alzheimers.org.uk/download/downloads/id/3622/urinary_tract_infections_utis_and_
dementia.pdf [Accessed 14 Jan. 2018].
Barber, A.E., Norton, J.P., Spivak, A.M. and Mulvey, M.A., 2013. Urinary tract infections:
current and emerging management strategies. Clinical infectious diseases, 57(5), pp.719-724.
Bien, J., Sokolova, O. and Bozko, P., 2012. Role of uropathogenic Escherichia coli virulence
factors in development of urinary tract infection and kidney damage. International journal of
nephrology, 2012.
Cai, T., Mazzoli, S., Mondaini, N., Meacci, F., Nesi, G., D'elia, C., Malossini, G., Boddi, V. and
Bartoletti, R., 2012. The role of asymptomatic bacteriuria in young women with recurrent urinary
tract infections: to treat or not to treat?. Clinical infectious diseases, 55(6), pp.771-777.
Contreras-Martel, C., Martins, A., Ecobichon, C., Trindade, D.M., Matteï, P.J., Hicham, S.,
Hardouin, P., El Ghachi, M., Boneca, I.G. and Dessen, A., 2017. Molecular architecture of the
PBP2–MreC core bacterial cell wall synthesis complex. Nature Communications, 8(1), p.776.
Cortes-Penfield, N.W., Trautner, B.W. and Jump, R.L., 2017. Urinary Tract Infection and
Asymptomatic Bacteriuria in Older Adults. Infectious Disease Clinics, 31(4), pp.673-688.

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Dailymed.nlm.nih.gov (2018). AMOXICILLIN AND CLAVULANATE POTASSIUM TABLETS
USP, 500 mg/125 mg and 875 mg/125 mg22742275. [online] Dailymed.nlm.nih.gov. Available
at: https://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=3024 [Accessed
17 Jan. 2018].
Darouiche, R.O. and Hull, R.A., 2012. Bacterial interference for prevention of urinary tract
infection. Clinical infectious diseases, 55(10), pp.1400-1407.
Das, R.N. and Grimmer-Somers, K.A., 2012. Fluid intake and voiding; habits and health
knowledge in a young, healthy population. Research and reports in urology, 4, p.9.
De Cock, P.A., Standing, J.F., Barker, C.I., de Jaeger, A., Dhont, E., Carlier, M., Verstraete,
A.G., Delanghe, J.R., Robays, H. and De Paepe, P., 2015. Augmented renal clearance implies a
need for increased amoxicillin-clavulanic acid dosing in critically ill children. Antimicrobial
agents and chemotherapy, 59(11), pp.7027-7035.
Doern, C.D. and Richardson, S.E., 2016. Diagnosis of Urinary Tract Infections in
Children. Journal of clinical microbiology, 54(9), pp.2233-2242.
Durojaiye, C.O. and Healy, B., 2015. Urinary tract infections: diagnosis and
management. Prescriber, 26(11), pp.21-29.
Flores-Mireles, A.L., Walker, J.N., Caparon, M. and Hultgren, S.J., 2015. Urinary tract
infections: epidemiology, mechanisms of infection and treatment options. Nature reviews
microbiology, 13(5), pp.269-284.
Foxman, B., 2014. Urinary tract infection syndromes: occurrence, recurrence, bacteriology,
risk factors, and disease burden. Infectious Disease Clinics, 28(1), pp.1-13.

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Fünfstück, R., Nicolle, L.E., Hanefeld, M. and Naber, K.G., 2012. Urinary tract infection in
patients with diabetes mellitus. Clinical nephrology, 77(1), p.40.
Garcia, T.A., Ventura, C.L., Smith, M.A., Merrell, D.S. and O'Brien, A.D., 2013. Cytotoxic
necrotizing factor 1 and hemolysin from uropathogenic Escherichia coli elicit different host
responses in the murine bladder. Infection and immunity, 81(1), pp.99-109.
Goldstein, I., Dicks, B., Kim, N.N. and Hartzell, R., 2013. Multidisciplinary overview of
vaginal atrophy and associated genitourinary symptoms in postmenopausal women. Sexual
medicine, 1(2), pp.44-53.
Guneysel, O., Suman, E. and Cimilli Ozturk, T., 2016. Trimethoprim-sulfamethoxazole
resistance and fosfomycin susceptibility rates in uncomplicated urinary tract infections: time
to change the antimicrobial preferences. Acta Clinica Croatica, 55(1.), pp.49-57.
Gupta, O.P. and Aggarwal, K.K., 2012. Role of Phenazopyridine in Urinary Tract Infections.
Hooton, T.M., 2012. Uncomplicated urinary tract infection. New England Journal of
Medicine, 366(11), pp.1028-1037.
Hotchandani, R. and Aggarwal, K.K., 2012. Urinary Tract Infections in Women.
Kim, H.K., Kang, S.Y., Chung, Y.J., Kim, J.H. and Kim, M.R., 2015. The recent review of
the genitourinary syndrome of menopause. Journal of menopausal medicine, 21(2), pp.65-71.
Komala, M. and Kumar, K.S., 2013. Urinary tract infection: causes, symptoms, diagnosis and
it's management. Indian Journal of Research in Pharmacy and Biotechnology, 1(2), p.226.
Kudinha, T., Johnson, J.R., Andrew, S.D., Kong, F., Anderson, P. and Gilbert, G.L., 2013.
Distribution of phylogenetic groups, sequence type ST131, and virulence‐associated traits

20LOWER URINARY TRACT INFECTION
among Escherichia coli isolates from men with pyelonephritis or cystitis and healthy
controls. Clinical Microbiology and Infection, 19(4).
Lewis, A.J., Richards, A.C. and Mulvey, M.A., 2016. Invasion of Host Cells and Tissues by
Uropathogenic Bacteria. Microbiology spectrum, 4(6).
Lockwood, W., 2017. Upper Urinary Tract Infections.
Mambatta, A.K., Jayalakshmi Jayarajan, V.L.R., Harini, S., Menon, S. and Kuppusamy, J.,
2015. Reliability of dipstick assay in predicting urinary tract infection. Journal of family
medicine and primary care, 4(2), p.265.
Medicines.org.uk (2018). [online] Available at:
https://www.medicines.org.uk/emc/medicine/21728 [Accessed 10 Jan. 2018].
Medsafe.govt.nz (2018). Cite a Website - Cite This For Me. [online] Medsafe.govt.nz. Available
at: http://www.medsafe.govt.nz/profs/Datasheet/a/Augmentintabsusp.pdf [Accessed 17 Jan.
2018].
Mhra.gov.uk (2018). Cite a Website - Cite This For Me. [online] Mhra.gov.uk. Available at:
http://www.mhra.gov.uk/home/groups/spcpil/documents/spcpil/con1510288692735.pdf
[Accessed 10 Jan. 2018].
Mnif, M.F., Kamoun, M., Kacem, F.H., Bouaziz, Z., Charfi, N., Mnif, F., Naceur, B.B.,
Rekik, N. and Abid, M., 2013. Complicated urinary tract infections associated with diabetes
mellitus: Pathogenesis, diagnosis and management. Indian journal of endocrinology and
metabolism, 17(3), p.442.

21LOWER URINARY TRACT INFECTION
Mody, L. and Juthani-Mehta, M., 2014. Urinary tract infections in older women: a clinical
review. Jama, 311(8), pp.844-854.
Ncbi.nlm.nih.gov (2018). [online] Available at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1326933/ [Accessed 14 Jan. 2018].
Nhsdirect.wales.nhs.uk (2018). NHS Direct Wales - Encyclopaedia : Kidney infection.
[online] Nhsdirect.wales.nhs.uk. Available at:
http://www.nhsdirect.wales.nhs.uk/encyclopaedia/k/article/kidneyinfection/ [Accessed 10
Jan. 2018].
Nice.org.uk (2018). Antibiotic resistance is now “common” in urinary tract infections. [online]
NICE. Available at: https://www.nice.org.uk/news/article/antibiotic-resistance-is-now-common-
in-urinary-tract-infections [Accessed 17 Jan. 2018].
Nicolle, L.E., 2014. Catheter associated urinary tract infections. Antimicrobial resistance and
infection control, 3(1), p.23.
Nmc.org.uk (2018). Cite a Website - Cite This For Me. [online] Nmc.org.uk. Available at:
https://www.nmc.org.uk/globalassets/sitedocuments/standards/nmc-standards-for-medicines-
management.pdf [Accessed 10 Jan. 2018].
Nrsng.com (2018). Nursing Care Plan for Urinary tract infection (UTI) | NRSNG. [online]
NRSNG. Available at: https://www.nrsng.com/care-plan/urinary-tract-infection-uti/
[Accessed 10 Jan. 2018].
Poopola, M., 2015. Holistic and Complementary Therapies.

22LOWER URINARY TRACT INFECTION
Ramlakhan, S., Singh, V., Stone, J. and Ramtahal, A., 2014. Clinical options for the
treatment of urinary tract infections in children. Clinical medicine insights. Pediatrics, 8,
p.31.
Robinson, D., Toozs-Hobson, P. and Cardozo, L., 2013. The effect of hormones on the lower
urinary tract. Menopause international, 19(4), pp.155-162
Rowe, T.A. and Juthani-Mehta, M., 2014. Diagnosis and management of urinary tract
infection in older adults. Infectious disease clinics of North America, 28(1), p.75.
Shaikh, S., Fatima, J., Shakil, S., Rizvi, S.M.D. and Kamal, M.A., 2015. Antibiotic resistance
and extended spectrum beta-lactamases: Types, epidemiology and treatment. Saudi journal of
biological sciences, 22(1), pp.90-101.
Silva, R.A.R.D., Bezerra, M.X., Souza Neto, V.L.D., Mororo, D.D.S. and Andrade, I.C.F.D.,
2017. Children with kidney diseases: association between nursing diagnoses and their diagnostic
indicators. Acta Paulista de Enfermagem, 30(1), pp.73-79.
Smee, N., 2012. Investigations into the urinary tract (Doctoral dissertation, Kansas State
University).
Subashchandrabose, S. and Mobley, H.L.T., 2015. Virulence and fitness determinants of
uropathogenic Escherichia coli. Microbiology spectrum, 3(4).
Tan, C.W. and Chlebicki, M.P., 2016. Urinary tract infections in adults. Singapore medical
journal, 57(9), p.485.
Thambavita, D., Galappatthy, P., Mannapperuma, U., Jayakody, R.L., Cristofoletti, R.,
Abrahamsson, B., Groot, D.W., Langguth, P., Mehta, M., Parr, A. and Polli, J.E., 2017.

23LOWER URINARY TRACT INFECTION
Biowaiver Monograph for Immediate Release Solid Oral Dosage Forms: Amoxicillin
Trihydrate. Journal of Pharmaceutical Sciences.
Wang, C.H., Fang, C.C., Chen, N.C., Liu, S.S.H., Yu, P.H., Wu, T.Y., Chen, W.T., Lee, C.C.
and Chen, S.C., 2012. Cranberry-containing products for prevention of urinary tract
infections in susceptible populations: a systematic review and meta-analysis of randomized
controlled trials. Archives of internal medicine, 172(13), pp.988-996.
Welch, R.A., 2016. Uropathogenic Escherichia coli-associated exotoxins. Microbiology
spectrum, 4(3).
Worthington, R.J. and Melander, C., 2013. Overcoming resistance to β-lactam antibiotics. The
Journal of organic chemistry, 78(9), pp.4207-4213.
Wwl.nhs.uk (2018). Cite a Website - Cite This For Me. [online] Wwl.nhs.uk. Available at:
https://www.wwl.nhs.uk/Library/FOI/Requests/2013-2014/December_2013/1911_Antibitotic
_Prescribing_Policy_June16.pdf [Accessed 10 Jan. 2018].
Young, P.J. and Saxena, M., 2014. Fever management in intensive care patients with
infections. Critical care, 18(2), p.206.
Zatorski, C., Zocchi, M., Cosgrove, S.E., Rand, C., Brooks, G. and May, L., 2016. A single
center observational study on emergency department clinician non-adherence to clinical practice
guidelines for treatment of uncomplicated urinary tract infections. BMC infectious
diseases, 16(1), p.638.

24LOWER URINARY TRACT INFECTION
Zhao, W.P., Li, Y.T., Chen, J., Zhang, Z.G., Jiang, H., Xia, D., Wang, S. and Wang, P., 2012.
Prostatic calculi influence the antimicrobial efficacy in men with chronic bacterial
prostatitis. Asian journal of andrology, 14(5), p.715.