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Antimicrobial MTM Case
Antimicrobial MTM Case
Introduction
- UTIs are common, especially among women.
- UTIs in men are less common and primarily occur after 50 years of age.
- UTIs infection usually occur by ascending route (urethra to bladder)
- UTIs infection is less common by haematogenous spread (kidney)
- UTIs occur in two general settings: community- acquired and hospital acquired.
- Urethritis : Infection of anterior urethral tract dysuria, urgency and frequency of micturition
- Dysuria ;(burning pain on passing urine)
- Urgency ;(the urgent need to pas urine) – Frequency of micturition
- Cystitis : Infection of urinary bladder dysuria, frequency, pyuria and haematuria
- Bacteriuria: Presence of bacteria in urine A count of 100 organisms/ml or more in urine
- Pyuria : Presence of pus in urine (more than 10 cells/HPF)
- Pyelonephritis: Infection of kidney ; flank pain, pyuria, fever, chills, nausea
Clinical Features
Acute lower UTIs (Urithritis and cystitis):
Rapid onset of:
– Dysuria (burning pain on passing urine)
– Urgency (the urgent need to pas urine)
– Frequency of micturition
Upper UTIs (Pyelonephritis):
– Fever
– Chills
– Dysuria
-Urgency
-Frequency of micturition
– Etiology Of Urinary Tract Infections Causative organisms:
1- Bacterial 2- Viral 3- Fungal 4- Protozoal
Other Risk Factors
1. Sex
2. Anatomy and Physiology of woman’s organ.
3. Urinary Catheters.
4. In Children’s; Due to Vesicoureteral reflux.
5. Hyperplasia: causes obstruction of the urethra.
6. Diabetes.
A 58-years-old woman (89kg) with a history of hypertension, dyslipidemia, and hypothyroidism, has presented to the Primary Health clinic with Fever and high grade chills, Headache & body-ache, Loose stools, and 2-3 vomiting episodes. The present case was diagnosed as that of Urinary tract infection. Ciprofloxacin 500mg Bid for 10 days was prescribed. After one week, she presented to the ER with similar complaints, in addition to fatigue.
Comprehensive Medication Review
Patient Specific Data
Age: 58
Sex: F
Nationality: Saudi
History of Illness: Hypertension,
Dyslipidemia, Hypothyroidism
Weight: 89 kg
Previous Surgeries: C/S
No known allergies
Symptoms: Fever, chills, body-ache, diarrhea, fatigue
BP = 130/90 mmHg
Temp. = 37.9 C◦
RR = 24/min
PR = 108/min
Current diagnosis: UTI
Medication Therapy Assessment
Personal Medication List
Medication Action Plan
The patient is advised to:
Separate levothyroxine administration with ciprofloxacin and caltrate-D by several hours to minimize decreased level of levothyroxine.
Not to take ciprofloxacin with dairy products.
Drink plenty of fluids. This includes water, juice, or other caffeine-free drinks.
Empty your bladder. Always empty your bladder when you feel the urge to urinate. And always urinate before going to sleep.
Practice good personal hygiene. Wipe yourself from front to back after using the toilet.
Seek urological consultation ASAP, further analysis is required.
The patient is advised to:
Separate levothyroxine administration with ciprofloxacin and caltrate-D by several hours to minimize decreased level of levothyroxine.
Not to take ciprofloxacin with dairy products.
Drink plenty of fluids. This includes water, juice, or other caffeine-free drinks.
Empty your bladder. Always empty your bladder when you feel the urge to urinate. And always urinate before going to sleep.
Practice good personal hygiene. Wipe yourself from front to back after using the toilet.
Seek urological consultation ASAP, further analysis is required.
Comprehensive Medication Review For Patients on Antimicrobials
- Reviewing patient’s medications and collecting patient-specific data.
- Assess and identify any wrongful or inappropriate use of antimicrobial medications.
- The pharmacist should review other medications prescribed to the patient and identify potential drug interactions.
- List and prioritize medication-related problems.
- Reviewing the current clinical practice on the use of antimicrobial medications.
- Pharmacists should frequently monitor the antimicrobial charts and make daily audits.
- Ensuring that the protocol is strictly followed and adhered during therapy.
- Latest lab reports should be available for all patients taking antimicrobial. In addition, drug levels for narrow therapeutic index medications should be available.
- verbal orders and abbreviations should be avoided in all medication orders.
- Adopting specific antimicrobial management service programs for safe monitoring and controlling the use of antimicrobials “Antimicrobial Stewardship Program”.
Points to Consider
1. Personal Medication Record (PMR)
Patients should be instructed to keep a record of all the medications they are prescribed, whether from the over-the-counter or as prescriptions. Antimicrobial MTM Case
In their medication list, patients should be instructed to record:
- Name of the medication, dosage, indication, duration of the prescription, and special instructions regarding the medications.
- Any medication prescribed when the medication list had been prepared should be added to the list. Therefore, the patient should be instructed on the appropriate format for preparing a medication list that allows for space for adjustment .
- Over-the-counter items should be added to the list, and the time they were administered.
- If possible, the patient can document the name and personal details of the physician who made the prescription. The aim of such a list is to help trace the prescription in case of a medical problem.
Patients should be instructed and reminded to carry the list any time they are visiting a healthcare facility.
2. Personal Medication Record (PMR)
3. Medication Action Plan
In creating MAP, reviewing current guidelines helps in the objective assessment of antimicrobial use. Antimicrobial MTM Case. The following are examples of different infections, with their related antimicrobial guidelines:
4. Intervention and Referral
The pharmacist provides consultative services and intervenes to address medication-related problems.Antimicrobial MTM Case
when necessary, the pharmacist refers the patient to a physician or other healthcare professional.
The ability of the patient to respond to the medication is not only evaluated by their overall positive or negative health outcomes but also through other clinical processes.
Lab work is essential for truly assessing patient outcomes.
If the measurements show exaggerated values, it becomes essential for the medical team to stop the medication as soon as possible and consider other potential antibiotics.
This promotes patient safety and makes sure that they can achieve a positive recovery process. This promotes continuity of care through the recommendation of more safe antibiotic.
Main complaints has not been resolved, referral to urologist for initiation of an alternative.
Culture analysis was not made prior initiation of ciprofloxacin; intervention with urologist to use empirical “Augmentin 1gm BID” treatment for 72 hours, according to the guidelines, until culture is obtained.
Ciprofloxacin is reported to have moderate interaction with levothyroxine as well as atorvastatin; further referral to the internal medicine is required.
Pathway/ Protocol
5. Documentation and follow up
At all stages, the pharmacist should ensure that all interventions are well documented. Antimicrobial MTM Case
Once patient is alert, explain why drug was given.
Reassure patient he will be monitored continuously until he is stable.
If the patient will be remaining in the same care setting, the pharmacist should arrange for consistent follow-up MTM services in accordance with the patient’s unique medication-related needs. All follow-up evaluations and interactions with the patient and his or her other healthcare professional should be included in MTM documentation.
References
1.Chaar, A., & Feuerstadt, P. 2021. Evolution of clinical guidelines for antimicrobial management of Clostridioides difficile infection. Therapeutic advances in gastroenterology, 14, 17562848211011953. 1-35.
2.Ness, V., Sneddon, J., Seaton, R. A., Malcolm, W., & Currie, K. 2021. Factors influencing the stewardship activities of Antimicrobial Management Teams: a national cross-sectional survey. Journal of Hospital Infection. p. 33-65.
3.Rawson, T. M., Moore, L. S. P., Hernandez, B., Charani, E., Castro-Sanchez, E., Herrero, P., … & Holmes, A. H. 2017. A systematic review of clinical decision support systems for antimicrobial management: are we failing to investigate these interventions appropriately? Clinical Microbiology and Infection, 23(8), 524-532.
4.Yang, J., Zheng, L., Guan, Y., & Song, C. 2020. Analysis of the impact of antimicrobial management and rational use of antibiotics. European Journal of Hospital Pharmacy, 27(5), 286-291.
5.https://www.moh.gov.sa/en/CCC/healthp/regulations/Documents/National%20Antimicrobial%20%20Guidelines.pdf
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