Evaluation and Assessment of Drug Utilization in Patients of Urinary Tract Infections

 

Yogesh Joshi*, Punam Gurung, Siddhi Jain

Department of Pharmaceutical Science, Shri Guru Ram Rai Institute of Technology and Science,

Shri Guru Ram Rai University, Dehradun-248001, Uttarakhand, India

*Corresponding Author E-mail: yogeshjoshi1583@rediffmail.com

 

ABSTRACT:

Urinary Tract Infections (UTIs) are among the typical bacterial infections occurring in both genders but considered a key public health issue causing morbidity, especially in women population. The present study was aimed to assess the drug utilization evaluation in patients of urinary tract infections from different hospitals and clinics. The study was carried out on both in-patients as well as out-patients, which were currently being following the treatment of urinary tract infections. All the necessary and relevant information were collected from outpatient department cards, treatment charts, laboratory data reports, patient history records and verbal communication with patients. Demographic analysis revealed that among a total of 110 patients, female patients were more in number than male patients. Age wise distribution showed that majority of UTIs patients (56.36%) were between 21-40 years of age. All patients were prescribed with antibiotics. Other drugs like analgesics, anti-emetics, antacids, smooth muscle relaxants, etc. were prescribed according to the complaints of the patients. Most commonly prescribed antibiotics were nitrofurantoin (63.63%) and amikacin (51.81%). The average number of drugs per patients reflected that patients with more than 5 drugs prescribed may result in polypharmacy. Rational use of drugs should be enhanced by the use of appropriate drugs while polypharmacy should be discouraged so as to reduce the risk of drug interactions. Appropriate treatment and sanitation is very important for the management of the disease and follow up is necessary to minimize the consequences of UTIs.

 

KEYWORDS: Urinary tract infections, antibiotics, polypharmacy, complications, drug utilization

 

 


INTRODUCTION:

Urinary Tract Infections (UTIs) are the typical bacterial infections and affects the different parts of urinary tract, the event is found both in males and females, both genders are susceptible to urinary tract infections. It is a key public health issue causing morbidity, especially in women population. The problem is further aggravated in pregnant women.

 

 

It usually refers to the presence of microorganisms in the urinary tract together with symptoms. The symptoms includes mostly cystitis (bladder infection), pyelonephritis (kidney infection) and urethritis (urethra infection) denote tissue damage, burning, painful urination, urgency and increased urinary frequency, suprapubic pain, pain in renal angle, fever and other systemic manifestations but asymptomatic cases also occur[1-4].

 

Urinary Tract Infection is most widely recognized bacterial contamination in human population. Its yearly worldwide incidence is almost 250 million. UTIs refer to the presence of microbial pathogens within the urinary tract and it is usually classified by the site of infection; upper and lower urinary tract infection. Any anatomical obstruction such as prostatic hypertrophy, neurogenic disorder, tumor, stone and catheter adds to the advancement of UTI. Symptoms of UTI rely on the distinct organ defected and type of organism causing the disease[3].

 

Urinary Tract Infection exists when pathogenic microorganisms are identified in the urine, urethra, bladder, kidney, or prostate with or without the presence of exact symptoms. In most situations, addition of more than 105 organisms per milliliter from the urine appropriately collected, and then urine test demonstrates infection[4].

 

Common invading pathogens which are responsible for UTIs are Escherichia coli, Klebsiella, Proteus, Pseudomonas, Streptococci, Gram negative enteric bacteria and yeasts. In women, bacterial cystitis is the mostly well known bacterial infection. Each woman has 60% risk of creating bacterial cystitis. The causative organism of urinary tract infection changes from place to place and they also changes in their susceptibility and resistance patterns[3].

 

Patient with UTI typically present with any or all of the following symptoms-

·         Burning pain on urination (dysuria)

·         Urinary frequency or urgency

·         Urinary incontinence (leakage)

·         Blood in the urine

·         Foul smelling urine

·         Fever may be present in more serious infection [5].

 

Severe symptoms of UTI are more predictable than milder ones. Complains of vaginal discharge or vaginal irritation and the absence of dysuria or back pain reduce the like hood of UTI. Pyelonephritis typically causes fever, chills, malaise, flank discomfort, nausea/vomiting and abdominal pain, with or without concomitant lower urinary tract signs. Older patients can present more of the diagnostic challenge and may have nonspecific symptoms [6].

 

MATERIAL AND METHODS:

Study Design:

A prospective and observational study was carried out through study of data regarding the medication history of patient, their present illness and current medication.

 

Study Sites:

The study was carried out in different hospitals and clinics of Dehradun (Uttarakhand) for collection of data.

 

Study Setting:

The study was carried out on both in-patients as well as on out-patients, who were currently being following the treatment of urinary tract infection in the hospitals or clinics.

 

Study Duration:

The study duration was from the month of February 2018 to April 2018.

 

Source of data:

All the necessary and relevant information were collected from outpatient department cards, treatment charts, laboratory data reports, patient history records and verbal communication with patients.

 

Collection of data:

The data was collected on the format prepared as per WHO based guidelines, which involved patient as well as medication information.

 

RESULTS AND DISCUSSION:

During the study period, 110 patients of UTIs were included to assess the drug utilization among patients at various hospitals and clinics of Dehradun. The gender wise distribution of patients was shown in Figure 1. It was observed that female patients were 80 (72.72%) while male patients were 30 (27.28%). Females are more susceptible to UTIs than males because in females the urethra is much shorter and closer to anus than in males. The female genital tract is closely interconnected to the bladder and their relationship makes the spread of diseases possible from one tract to the other tract. The patients were categorized into four groups according to age wise distribution as shown in Table 1. It was observed that majority of patients susceptible to UTIs were between 21-40 years of age (56.36%) while 3.63% from the age group of less than 20 years, 21.82% from the age group of 41-60 years and 18.18% from the age group of 61-80 years. The patients were categorized according to their socio economic status into three major groups; lower class, middle class and higher class according to their family’s income in monthly basis as shown in Figure 2. The people having low socio-economic status were more prone to urinary tract infection than other class because of different lifestyles and eating habits.

 

 

Figure 1: Gender wise distribution of patients

 

Table 1: Age wise distribution of patients

Age (Years)

Number of Patients (%) (n=110)

<20

04 (3.63%)

21-40

62 (56.36%)

41-60

24 (21.82%)

61-80

20 (18.18%)

 

Figure 2: Socio-economic distribution of patients

 

Different categories of drugs were prescribed in the treatment of UTIs. These categories include antibiotics, analgesics, smooth muscle relaxants, antacids, antiemetics, anti-fungals, polyherbals and others as shown in Figure 3. Among 110 patients, all patients were prescribed with antibiotics. Among antibiotics categories, most commonly prescribed antibiotics were nitrofurantoin (63.63%) and amikacin (51.81%) as shown in Table 2. The study showed varied number of drugs prescribed in different patients. The average number of drugs per patients was represented in Table 3. The patients with more than 5 drugs prescribed may result in polypharmacy. Most of the patients were treated without any kind of side effects. However, few patients went through some complications during the treatment. These complications were headache, gastrointestinal problems like diarrhea, body ache and chest pain. The numbers of patients undergoing such complications were shown in Table 4.

 

 

Figure 3: Prescribed drug categories

 

Table 2: Commonly prescribed antibiotics in UTI treatment

Name of Drugs

Number of Patients (%) (n=110)

Nitrofurantoin

70 (63.63%)

Amikacin

57 (51.81%)

Ceftriaxone and Tazobactam

35 (31.82%)

Levofloxacin

20 (18.18%)

Terbinafine

05 (4.54%)

Piperacillin and Tazobactam

29 (26.36%)

Gentamycin

23 (20.90%)

Ciprofloxacin

20 (18.18%)

Imipenem

10 (9.09%)

Clathromycin

20 (18.18%)

Cefixime

12 (10.90%)

Amoxicillin

13 (11.81%)

Erythromycin

20 (18.18%)

Moxifloxacin

06 (5.45%)

 

Table 3: Average number of drugs per patients

Average number of drugs

Number of Patients (n=110)

2

6

3

11

4

3

5

13

6

11

7

10

9

18

10

22

11

16

 

Table 4: Commonly occurring complications during treatment

Common Complications

Number of Patients (n=100)

Headache

2

Diarrhea

7

Body ache

5

Chest pain

3

 

CONCLUSION:

In the study, we observed that females were mostly affected than males by urinary tract infection. The most commonly used drugs among them are nitrofurantoin and amikacin. Rational use of drugs should be enhanced by the use of appropriate drugs. Polypharmacy should be discouraged so that it reduces the risk of drug interactions. All the UTIs should be treated periodically and sanitation is very important for the management of the disease. Continuous follow up is mandatory to minimize the consequences of asymptomatic and symptomatic UTIs.

 

REFERENCES:

1.        Vasudevan R. Urinary Tract Infection: An overview of the infection and the associated risk factor. Journal Microbiology Exp 2014; 1 (2): 08.

2.        Nerurkar A, Solankay P, Naik SS. Bacterial pathogen in urinary tract infection and antibiotic susceptibility pattern. Journal of pharmaceutical and biomedical science 2012; 21 (12): 1-3.

3.        Akter T, Mia Z, Shahriar M. Antibiotic sensitivity of pathogens causing urinary tract infection. Pharmaceutical journal 2013; 16 (1): 53-58.

4.        Joshi MC, Rashid MK. Study of antibiotic sensitivity pattern in urinary tract infection in a tertiary hospital. National journal of integrated research in medicine 2011; 2 (3): 44-46.

5.        Asati RK, Sdawarte K. Prevalence and antimicrobial susceptibility pattern of klebsiella pneumonia causing Urinary Tract Infection and issues related to rational selection of antimicrobials. Journal of applied sciences 2013; 1 (5): 395-399.

6.        Gibson K, Toscano J. Urinary Tract Infection update. Am.J.Clin.Med 2012; 9 (2): 82-86.

 

 

 

 

 

Received on 20.07.2018          Accepted on 06.08.2018        

© Asian Pharma Press All Right Reserved

Asian J. Pharm. Res. 2018; 8(3):  167-169.

DOI: 10.5958/2231-5691.2018.00029.1