Exam (elaborations) SNAPPS Template for Written Assignment May 2018_1

SNAPPS Template for Written Assignment May 2018_1 What is the self-directed learning issue that was identified in your oral presentation? Management of Recurrent Urinary Tract Infection in Women Research the self-directed learning issue and provide a summary of your findings which is fully supported by appropriate, scholarly, EBM references. Urinary tract infections (UTIs) are one of the most frequent clinical bacterial infections in women, accounting for nearly 25% of all infections. Around 50–60% of women will develop UTIs in their lifetimes. Approximately 20%–30% of women with a urinary tract infection (UTI) will have a recurrence. Escherichia coli is the organism that causes UTIs in most patients (Al- Badr & Al-Shaikh, 2013). Although the initial treatment is antimicrobial therapy, use of different prophylactic regimens and alternative strategies are available to reduce exposure to antibiotics. RUTIs can reduce quality of life and increase healthcare costs associated with outpatient visits, diagnostic tests and prescription. Recurrent UTIs (rUTIs) can be defined as at least three episodes of UTI in 1 year or two episodes in 6 months. Various antibiotics have been the mainstay of therapy in ameliorating the incidence of UTIs, but recurrent infections continue to afflict many women. It necessitates the exploitation of alternative antimicrobial therapy. Probiotics have been shown to be effective in varied clinical trials for long-term preventions of recurrent UTI. Because Escherichia coli is the primary pathogen involved in UTIs which spreads from the rectum to vagina and then ascends the sterile urinary tract, improving the gut or vaginal flora will thus impact the urinary tract (Gupta et, al., 2017). Clinicians should obtain a complete patient history and perform a pelvic examination in women presenting with rUTI. Women with RUTIs need to be properly investigated by urinalysis, urine cultures and other radiological techniques in order to rule out causes of recurrence, as well as to assess possible anatomical or functional urinary tract abnormalities. Although standard UTI therapy starts with antimicrobial therapy, alternative strategies are available to reduce exposure to antibiotics, such as the use of methenamine salts, probiotics, cranberry juice, immunoprophylaxis and vaginal estrogens in post-menopausal women. In peri– and post–menopausal women with Recurrent UTIs, clinicians should recommend vaginal estrogen therapy to reduce the risk of future UTIs if there is no contraindication to estrogen therapy. (Moderate Recommendation; Evidence Level Continuous antibiotic prophylaxis, postcoital prophylaxis, and