In this case, a patient is a 54-year-old man who is presented with such symptoms as sudden urgency to urinate, painful urination, and back pain during the last 48 hours. His urine test results reveal the presence of nitrites and leukoesterase, which tells about the possibility of a bacterial infection in the urinary tract (Bellazreg et al., 2019). To develop an effective treatment plan, it is important to ask the right questions, do physical examinations and diagnostics, and analyze differential diagnoses.
To get a better understanding of the patient’s condition, it is necessary to clarify the patient’s history and identify the sources of the problem. The following questions should be posed:
- Have you ever had a urinary tract infection before?
- Do you have some chronic diseases (diabetes, cancer, heart disease, etc.)?
- Are you sexually active?
- Have you experienced trauma recently?
- Do you take any antibiotics or other drugs?
- Do you observe shaking or chill during or after urination?
Regarding the already revealed symptoms and urinalysis findings, several differential diagnoses are appropriate for the patient. First, cystitis is a common urinary tract infection (UTI) that is characterized by painful urination, urgency, frequency, and a strong odder of cloudy urine (Tan & Chlebicki, 2016). This diagnosis is given as soon as a bacterial bladder infection is recognized, and the patient is positive for nitrites and leukoesterase.
Discomfort during urination and its urgency may be the signs of urethritis (either gonococcal or non-gonococcal). In addition to painful urination, the man could experience irritation in the penis and swelling in the testicles. Finally, pyelonephritis is a differential diagnosis that explains back pain and a strong urge to urinate (Tan & Chlebicki, 2016). A cloudy appearance of the urine and painful sensations indicate problems with kidneys, and this type of UTI requires timely medical attention.
A physical examination of a patient with UTI symptoms is a part of an overall evaluation, including medical history, current diagnosis, and risk factors. Any physical exam is crucial for checking vital signs (fever and tachycardia), costovertebral angle and suprapubic tenderness, hydration status, and urine abnormalities (color, odor, and the presence of other substances). Sometimes, a physical examination needs the assessment of the patient’s mental status (to reduce the risks of intoxication).
Any UTI diagnosis requires the analysis of a urine sample. At the moment of examination, the patient has already presented the urine dipstick results, and nitrites along with leukoesterase prove bacteria in the organism. Therefore, lab analysis of the urine (urine culture evaluation on a freshly voided sample) will help identify the type of bacteria that causes this infection (Bellazreg et al., 2019). Attention to these diagnostic features will facilitate the choice of the treatment process.
Plan of Care
Pharmacological and non-pharmacological recommendations must be followed in this patient’s case. As the man is allergic to Bactrim, the choice of antibiotics is critical because it is obligatory to avoid the drugs of the trimethoprim group. Antimicrobial therapy with ciprofloxacin 500 mg, twice per day during a week is a choice (Tan & Chlebicki, 2016). It is also possible to add co-trimoxazole, 960 mg, twice per day during the next two weeks (Tan & Chlebicki, 2016). Amoxicillin is also an appropriate agent to treat cystitis and other UTIs in male patients (Tan & Chlebicki, 2016). In the majority of cases, the duration of antibiotic intake is between one and two weeks. To reduce UTI-related complications, several non-pharmacological suggestions are given, including drinking water, avoiding alcohol, and improving knowledge about UTI prevention.
In general, UTIs have different forms but a number of common symptoms. As soon as the analysis of differential diagnoses and lab results is done, a doctor defines a true cause of current complaints and develops a treatment plan. In this case, the patient is allergic to Bactrim, and the choice of antibiotics plays a crucial role. Cooperation with the medical staff and following lifestyle recommendations are necessary for the patient.
Bellazreg, F., Abid, M., Lasfar, N. B., Hattab, Z., Hachfi, W., & Letaief, A. (2019). Diagnostic value of dipstick test in adult symptomatic urinary tract infections: Results of a cross-sectional Tunisian study. The Pan African Medical Journal, 33. Web.
Tan, C. W., & Chlebicki, M. P. (2016). Urinary tract infections in adults. Singapore Medical Journal, 57(9), 485-490. Web.