How to Treat Urinary Tract Infection

UTI Case Study

The case of L.J., a 23-year-old woman with no previous history of UTI, is one that represents a case of lower urinary tract infection. The gram negative rods on the gram stain are one of two types of bacteria classified that appear around the world; the gram negative classification is just a way to identify the type of bacteria associated with the infection: the bacteria have a thin peptidoglycan with a cell membrane and porins in the membrane. This is important to know, as the membrane guards the bacteria from various types of antibiotics that might otherwise be used. Knowing that the bacteria is gram negative instead of gram positive allows the health care provider to utilize an appropriate treatment method. This paper will discuss the possible treatment plans for L.J. in order to treat her UTI.

Pathophysiology

The pathophysiology of the urinary tract infection is that the pathogen causing the infection has colonized in the bladder; the bacteria can ascend the ureter to the kidney, where infection of the renal parenchyma is responsible for producing an inflammatory response, identified as pyelonephritis (a more serious infection) (Wagenlehner et al., 2011). Likewise, the bacteria typically cause cystitis, which contributes to the painful feeling in the body. What the body experiences, and what L.J. complains of, is a burning sensation when urinating (a result of the inflammation), and a feeling of needing to frequently urinate, along with bladder pain. The bladder is infected and this is what is causing the body to react with the sensation of pain and the need for frequent urination (Hooton, 2012).

Most Common Pathogens

The most common pathogen associated with UTI is E. coli in women (a result of feces entering into the urinary tract); in men, a common pathogen associated with UTI is P. aeruginosa; others include Klebsiella spp and Proteus spp (Linhares et al., 2013).

Reasonable Treatment Plan

The most reasonable treatment plan for L.J. is to take an antibiotic/antimicrobial and to have a culture performed in order to identify the bacteria so that the right treatment can be applied. The treatment recommended by the European Association of Urology is for care providers to use fosfomycin, trometamol, pivmecillinam (a type of penicillin), nitrofurantoin (a type of nitrofuran) as the options for first-line treatments. Alternative treatments can include fluoroquinolones or cepodoxime proxetil should resistance not be above 20% (Wagenlehner et al., 2011). While E. coli is the most common pathogen associated with UTIs in women, it does show resistance to sulfonamide SXT and fluoroquinolone ciprofloxacin in some studies (Linhares et al., 2013).

Duration of Treatment

The duration of the treatment should be 7 to 10 days, in accordance with typical guidelines associated with microbial therapy regarding UTI (Linhares et al., 2013). Because residual bacteria can colonize, the week to ten days commitment to treatment is to ensure that all bacteria are effectively killed.

Most Common Antimicrobials Used for Treatment

The most common antimicrobials used for treatment of urinary tract infections are Cipro (ciprofloxacin), Monurol (fosfomycin), Levaquin (levofloxacin), Furadantin, Macrobid, and Macrodantin (all nitrofurantoins), with Bactrim and Septra (sulfamethoxazole coupled with trimethoprim) also being used frequently in treatments associated with urinary tract infections for both men and women (Wagenlehner et al., 2011).

Relapse and Recurrent Infection

The difference between relapse and recurrent infection is that a relapse is what happens when the UTI is effectively treated and the bacteria killed, but the same conditions that allowed the UTI to occur in the first place are not remedied, and therefore the incidence keeps occurring. A recurrent UTI is one that is never effectively treated and thus it continues to flare up from time to time; the bacteria remain in the bladder and are not killed.

Recurring UTI

If this were a recurring UTI for L.J. (lasting more than 3-6 months in the last 12 months), I would not consider prophylaxis. The reason for this is that there are natural remedies to treating the infection that can be effectively employed to help correct the situation and treat the problem. Recommended practices would be to drink plenty of water, cranberry juice and to take vitamin C and vitamin D supplements on a regular basis. Drinking water is essential and very important because it helps to flush out the bladder, which for women as they age can sag and keep it from evacuating completely. Prophylaxis can be helpful but it can also make the lungs less elastic, which could be an unwanted side effect, that could be avoided through effective treatment using natural remedies. One major pragmatic treatment could be to teach L.J. how to correctly wipe herself following a defecation so as to ensure that no E. coli pathogens are entering her urinary tract; this can be a most advantageous lesson.

Pregnant

If L.J. were pregnant, I would treat her UTI in the same manner -- by recommending that she drink plenty of water to help wash it out. Water is a good instrument in keeping the bladder moving; this should be accompanied by vitamin C supplements either through cranberry juice or another intake mechanism, as the acidity can help reduce the bacteria (Hooton, 2012).

Possible Uses of Vitamins and Herbal Supplements as They Relate to Disease Management

Disease management allows for a collective experience of remedies and treatments to be managed and effectively communicated to a community of persons involved in the process of preventing the spread of the disease. The community works together to share their experiences about what works and what does not and in this way, both patients and physicians along with herbalists and natural homeopathic doctors can contribute to the management of the disease.

Possible uses of vitamins with relation to the UTI include vitamin C and vitamin D, as well as priobiotics and colloidal silver. As Barillo and Marx (2014) point out, "silver is a naturally occurring element" that in its ionized form "has known antimicrobial properties" (p. 3). Natural remedies of this kind can have strong appeal for persons in a disease management community and so can practical remedies associated with traditional and home-grown treatments, such as the flushing out of the system via the drinking of water. The imbibing of cranberry juice (a strong bearer of acidic content) can also be helpful in eliminating bacteria associated with the infection, and the combination of continued drinking of water along with vitamin C and D, probiotics to boost the immune system and natural mineral homeopathic remedies like the use of colloidal silver can contribute to effective disease management.