For safety, avoid going to pharmacies
and having the pharmacist issue drugs
for your symptoms prior to seeing a doctor
and getting tested. Yes, it may save
you the cost of consultations and tests
but when a complication arises it will be
much more costly managing as the opportunity
to properly diagnose the correct
bacteria and treat it has been lost.
As UTIs commonly occur in pregnancy,
complications can be preterm delivery with
very costly management of the premature
neonate, low birth weight in the infants,
with damage to the kidneys the UTI
can lead to hypertension, preeclampsia,
breakdown of blood cells - haemolysis,
and low platelets- thrombocytopaenia.
It is for this reason that healthcare workers
screen for Urinary Tract Infections in
pregnancy. In the event that an infection
is picked up during screening then prompt
treatment is required to prevent any
possible complications.
know which bacteria we are dealing with
and more importantly from the sensitivity
pattern we are able to establish which
antibiotics to use for proper response.
For safety I would recommend that we
all avoid going to pharmacies and having
the pharmacist issue drugs for your
symptoms prior to seeing a doctor and
getting tested. Yes, it may save you the
cost of consultations and tests but when
a complication arises it will be much more
costly managing as the opportunity to
properly diagnose the correct bacteria and
treat it has been lost.
Treatment can be directed at the cause
or symptoms. Antibiotics treat the cause
and we normally use antibiotics such as
amoxicillin, ampicillin, cephalosporins,
nitrofurantoin and trimethoprimsulfamethoxazole.
Various pain
medications like paracetamol, buscopan
can easily be used and paracetamol has the
advantage that it will also lower any fever
if present.
One afternoon just sitting in the clinic
attending to patients, I ask for the next
client and the nurse requests me to see
one client out of turn as she is in a lot of
pain. They have been instructed to gauge
patients and those that seem very sick
are given priority. Who is assisted in…
Michelle one of my antenatal clients with
her sister. She looks toxic and we just
request her to lie on the bed. She has a
fever about 390C with a very rapid pulse
about 104 beats per minute.
On enquiry it appears that she has been
unwell but thought she would get better
with time. It all started with some lower
abdominal pain and frequent visits to
the ladies’ room. She thought it was due
to the pregnancy especially as she is now
in the third trimester. The previous day
she vomited once but this morning woke
up with severe pain on her left side just
below the rib cage and has had about 4
bouts of vomiting hence her visit today.
It did not take a genius to figure out that
this was a classic case of pyelonephritis (a
kidney infection).
An upper UTI is when the kidneys
get involved - pyelonephritis. With
pyelonephritis the symptoms include
flank/back pain, fever, chills, nausea and/
or vomiting and this is usually preceded
by symptoms of a lower urinary tract
infection.
I quickly examined her and as per my
suspicions she was very tender in the area
we normally examine the kidney but the
baby was still growing well with a good
fetal heart rate. I informed Michelle we
had no choice but to admit her so I wrote
a quick admission note with the tests I
needed to be run and an initial treatment
plan and off she went to the hospital.
This was the start of intravenous (IV)
antibiotics, a lot of fluids, drugs to lower
her fever, relieve pain and stop vomiting.
Fortunately, she responded very well to
the treatment and was able to bounce back
to full health within a few days however
as it was a kidney infection she had to
continue the antibiotics for 2 weeks to
ensure the infection was cleared.
Michelle’s recovery is what every clinician
hopes for, however in this era of resistant
antibiotics sometimes the course is not so
smooth and rosy. If left untreated UTI’s
can lead to very serious consequences.
Complications include sepsis (when the
infection has spread into the blood),
kidney failure and/or damage, an abscess
(collection of pus), multiple organ failure
due to sepsis and in rare conditions even
death.
Prevention is always better than cure.
For the health of your urinary system it
is always recommended to drink plenty
of water. I remember one of my surgical
professors always used to say the solution
to pollution is dilution. Urinary tract
infections are like stagnant pools. When
you don’t drink sufficient quantities of
water the urine gets concentrated and the
flow of urine slows down. Because of this,
bacteria have time to grow and that is why
the urine appears cloudy or turbid.
Drinking plenty of water will make the
urine flow like a fast moving river hence
prevent accumulation of bacteria and
subsequently a UTI. Please drink plenty
of water, approximately 3 litres per day
and you will prevent many unpleasant
experiences.
Other prevention strategies include
drinking unsweetened cranberry juice or
taking cranberry pills, washing carefully
around the genitals and anus, passing
urine whenever the urge arises (at least
every 2-3 hours) and urinating before
and after having sex. Cranberry juice
contains compounds that make it difficult
for bacteria to attach to the lining of the
urinary tract thus preventing infection.
I hope the article has been insightful but
more importantly useful to you. Above all
keep safe!
Dr. Maureen Owiti is a practicing
Obstetrician Gynaecologist and
fertility consultant based in Nairobi.
You can commune with her on this
or related matters via email at:
[email protected].