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Fulltext Antibiotics for URTI and UTI -- prescribing in Malaysian primary care settings

Teng CL, Tong SF, Khoo EM, Lee V, Zailinawati AH, Mimi O, et al.

Aust Fam Physician, 2011 May;40(5):325-9.
PMID: 21597554

Background: Overprescription of antibiotics is a continuing problem in primary care. This study aims to assess the antibiotic prescribing rates and antibiotic choices for upper respiratory tract infections (URTI) and urinary tract infections (UTI) in Malaysian primary care.
Method: Antibiotic prescribing data for URTI and UTI was extracted from a morbidity survey of randomly selected primary care clinics in Malaysia.
Results: Analysis was performed of 1163 URTI and 105 UTI encounters. Antibiotic prescribing rates for URTI and UTI were 33.8% and 57.1% respectively. Antibiotic prescribing rates were higher in private clinics compared to public clinics for URTI, but not for UTI. In URTI encounters, the majority of antibiotics prescribed were penicillins and macrolides, but penicillin V was notably underused. In UTI encounters, the antibiotics prescribed were predominantly penicillins or cotrimoxazole.
Discussion: Greater effort is needed to bring about evidence based antibiotic prescribing in Malaysian primary care, especially for URTIs in private clinics.
Keywords: general practice, prescriptions, drug; upper respiratory tract infection; urinary tract infection; antibiotics, guideline; evidence based medicine
Study site: Klinik Kesihatan, Malaysia

Matched MeSH terms: Urinary Tract Infections/drug therapy*
An Intriguing Case of Purple Urine Bag Syndrome

Wan Sulaiman WA, Hoo FK, Inche Mat LN

Am J Med Sci, 2017 May;353(5):e9.
PMID: 28502345 DOI: 10.1016/j.amjms.2016.11.022
Matched MeSH terms: Urinary Tract Infections/etiology*; Urinary Tract Infections/microbiology
Age- and gender-specific normal post void residual urine volume in healthy adolescents

Lim LY, Chang SJ, Yang SS

J Pediatr Urol, 2023 Aug;19(4):367.e1-367.e6.
PMID: 37029009 DOI: 10.1016/j.jpurol.2023.03.026

INTRODUCTION: Elevated post void residual (PVR) is a significant risk factor for urinary tract infections (UTI). It is also a significant predictor of treatment outcomes in cases of vesicoureteral reflux, pediatric enuresis, and non-neurogenic LUT dysfunction. However, the absence of age-specific nomograms for adolescents may limit PVR's use in clinical practice.
OBJECTIVE: To establish age- and gender-specific normal PVR urine volume in adolescents.
MATERIAL AND METHODS: Healthy adolescents aged 12-18 years were recruited to undergo two uroflowmetry and PVR studies whenever they felt the urge to urinate. Adolescents with neurological disorders, known LUT dysfunction or UTI were excluded.
RESULTS: A total of 1050 adolescents were invited, but only 651 consented. Fourteen participants were excluded due to low bladder volume (BV 100 ml (n = 5) and missing information (n = 6). Ultimately, 894 uroflowmetry and PVR from 605 adolescents (mean age 14.6 ± 1.5 years) were analyzed. PVRs were higher in adolescents aged 15-18 years than in those aged 12-14 years (P 20 ml (7% BV) for males of both the age groups, and PVR >25 ml (9% BV) and PVR >35 ml (>10% BV) for females aged 12-14 and 15-18 years, respectively. Further investigation may be warranted if the repeat PVR is above the 95th percentile, i.e., PVR >30 ml (8% BV) and >30 ml (11% BV) for males aged 12-14 and 15-18 years, respectively, and PVR >35 ml (11% BV) and >45 ml (13% BV) for females aged 12-14 and 15-18 years, respectively.
CONCLUSION: PVR increases with age and varies by gender; thus, age-and gender-specific reference values should be used. Further data from other countries is required to determine whether the study's recommendations can be applied globally.

Matched MeSH terms: Urinary Tract Infections*
Fulltext Accuracy of urinalysis in detection of urinary tract infection in a primary care setting

Othman S, Chia YC, Ng CJ

Asia Pac Fam Med, 2003;2(4):206-212.

Aim: To determine the accuracy of urinalysis in the detection of urinary tract infection (UTI) in symptomatic patients at primary care level. Methods: A cross sectional study was undertaken on 100 patients with symptoms of UTI presenting at the Primary Care Clinic of University Malaya Medical Center, Kuala Lumpur, Malaysia during the months of August to November 1999. Their urine samples were tested simultaneously using urine dipstick, urine microscopy and urine culture. Urine culture was used as the gold standard and UTI was diagnosed when the urine culture showed a bacteria count of >= 105 organisms per mL. The sensitivity and specificity of each test was calculated. Results: The prevalence of UTI was 25% in symptomatic patients. The urine dipstick for leukocyte esterase, nitrite and red blood cell had sensitivities of 76, 56 and 76%, respectively. Their specificities were 60, 81 and 61%, respectively. Urine microscopy for leukocytes, red blood cells and bacterial count had sensitivities of 80, 52 and 84%, while their specificities were 76, 80 and 54%, respectively. Conclusion: The prevalence of UTI in the present study was low despite reported symptoms of UTI. Urinalysis is needed to support the diagnosis of UTI. In the present study, while there is accuracy in the urinalysis (as the sensitivities and specificities of various tests are comparable with other studies); lack of precision in each test because of the wide range of 95% confidence interval make it less reliable. Caution should be made in interpreting each test.

Matched MeSH terms: Urinary Tract Infections
Fulltext A fascinating case of the ‘purple urine bag syndrome'

Low, Qin Jian, Lim, Tzyy Hue, Teoh, Kuo Zhau, Siow, Garry Peir Woeei, Go, Zher Lin, Tee, Vern Jun, et al.

Borneo Journal of Medical Sciences, 2018;12(3):59-62.
MyJurnal

Purple urine bag syndrome (PUBS) is a rare presentation of urinary tract infections (UTIs). It is commonly seen in constipated patients. There is a deep purple discoloration of contents of urine bag due to presence of indigo and indirubin pigments which are metabolites of tryptophan. We would like to describe an interesting case of purple urine bag syndrome of 88-year-old woman who presented with catheter-related urinary tract infection. She had low-grade fever and suprapubic discomfort for three days duration. She had increased white cell count and C-reactive peptide (CRP). Urinalysis showed protein 2+, nitrite and leucocyte esterase positive. Urine culture grew Escherichia coli and Klebsiella pneumoniae. She was treated with oral cefuroxime and recovered. This case report may be the first case of PUBS reported in this region.

Matched MeSH terms: Urinary Tract Infections
A PROspective study on the Usage patterns of Doripenem in the Asia-Pacific region (PROUD study)

Mustafa M, Chan WM, Lee C, Harijanto E, Loo CM, Van Kinh N, et al.

Int J Antimicrob Agents, 2014 Apr;43(4):353-60.
PMID: 24636429 DOI: 10.1016/j.ijantimicag.2014.01.017

Doripenem is approved in the Asia-Pacific (APAC) region for treating nosocomial pneumonia (NP) including ventilator-associated pneumonia (VAP), complicated intra-abdominal infections (cIAIs) and complicated urinary tract infections (cUTIs). Clinical usage of doripenem (500mg intravenously, infused over 1h or 4h every 8h for 5-14 days) in APAC was evaluated in a prospective, open-label, non-comparative, multicentre study of inpatients (≥18 years) with NP, VAP, cIAI or cUTI. A total of 216 [intention-to-treat (ITT)] patients received doripenem: 53 NP (24.5%); 77 VAP (35.6%); 67 cIAI (31.0%); and 19 cUTI (8.8%). Doripenem MIC90 values for Pseudomonas aeruginosa, Acinetobacter baumannii, Escherichia coli and Klebsiella pneumoniae were 32, 32, 0.094 and 0.64μg/mL, respectively. Doripenem was used most commonly as monotherapy (86.6%) and as second-line therapy (62.0%). The clinical cure rate in clinically evaluable patients was 86.7% at the end of therapy (EOT) and 87.1% at test of cure (TOC) (7-14 days after EOT). In the ITT population, overall clinical cure rates were 66.2% at EOT and 56.5% at TOC. The median duration of hospital stay, intensive care unit (ICU) stay and mechanical ventilation was 20, 12 and 10 days, respectively. Of 146 discharged patients, 7 were re-admitted within 28 days of EOT; 1 VAP patient was re-admitted to the ICU. The all-cause mortality rate was 22.7% (49/216). The most common treatment-related adverse events were diarrhoea (1.4%) and vomiting (1.4%). Doripenem is a viable option for treating APAC patients with NP, VAP, cIAI or cUTI. [ClinicalTrials.gov: NCT 00986102].

Matched MeSH terms: Urinary Tract Infections/drug therapy*; Urinary Tract Infections/microbiology; Urinary Tract Infections/mortality
Fulltext A Case of a Large Sub-retinal Abscess Secondary to Klebsiella pneumoniae Endophthalmitis in a Pyelonephritis Patient

Mohd-Ilham I, Zulkifli M, Yaakub M, Muda R, Shatriah I

Cureus, 2019 May 14;11(5):e4656.
PMID: 31316877 DOI: 10.7759/cureus.4656

Endogenous endophthalmitis is an ocular emergency, with severe sight-threatening complications. We report a case of unilateral endogenous Klebsiella pneumonia endophthalmitis with a large sub-retinal abscess in a 39-year-old lady that developed four days after presentation with sepsis secondary to urinary tract infections and pyelonephritis. Despite immediate treatment with intravenous (IV) and intravitreal antibiotics, her eye condition deteriorated. A pars plana vitrectomy was performed, and the sub-retinal abscess was removed, followed by silicone oil tamponade. Subsequently, she regained her vision to 6/36 with complete regression of the intraocular inflammation and sub-retinal abscess.

Matched MeSH terms: Urinary Tract Infections
Fulltext 24-hour discharge post Laparoscopic Ovarian Cystectomy: a feasibility study

Wan Ahmad Hazim, Nur Hidayah Aeshah Ng, Salleha Khalid

Pertanika Journal of Science & Technology, 2018;26(2):719-728.
MyJurnal

Minimally invasive surgery results in faster recovery. The objective of this study is to identify criteria for the feasibility of 24-hour discharge post laparoscopic ovarian cystectomy. This is a prospective cross-sectional study that was carried out at the Obstetrics and Gynaecology Department in Putrajaya Hospital between 1 January and 31 December, 2016. The inclusion criteria were: age between 15 and 45, no comorbidities, no family history of malignancy, BMI of less than 30, mass size less than 18 weeks, single uninoculated simple cyst and no ascites. The exclusion criteria were post-menopause women, known medical illness, family history of malignancy, mass size more than 18 weeks, multiloculated or bilateral ovarian cyst, presence of solid area within the cyst and ascites. The sample size was calculated to be 14. A total of 16 participants were identified. Results showed that using the Visual Analogue Score (VAS), the mean pain score post operatively in the first six hours, 24 hours, 48 hours, two weeks and three months were 3.67, 2.57, 0.5, 0 and 0, respectively. Two of the subjects experienced post-operative nausea and vomiting, one had urinary tract infection and one had minor bleeding from the surgical site. All the participants were discharged within 24 hours post-operatively. There was no readmission. In conclusion, 24-hour discharge post laparoscopic cystectomy is safe and feasible. Factors determining the success must be adhered to closely to ensure a good and satisfactory outcome. This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Matched MeSH terms: Urinary Tract Infections