Urinary tract infection (UTI) is
the term used to describe acute urethritis and cystitis caused by a
microorganism. Urinary tract infections (UTIs) are considered to be the most
common bacterial infection. In US, According to the 1997 National Ambulatory
Medical Care Survey and National Hospital Ambulatory Medical Care Survey, UTI
accounted for nearly 7 million office visits and 1 million emergency department
visits, resulting in 100,000 hospitalizations. The prevalence of UTI in women is about 3% at the age of 20,
increasing by about 1% in each subsequent decade.
Various clinical risk factors
for UTI in Diabetes Mellitus have been proposed, such as poor glycemic control,
duration of disease, diabetic microangiopathy, impaired leukocyte function
secondary to hyperglycemia, recurrent vaginitis, and anatomic and functional
abnormalities of the urinary tract associated with DM. The pathogenesis of UTI
among patients with DM appears to be multifactorial, with such diverse risk
factors as bladder dysfunction, alterations in immune function, and
instrumentation of the urinary tract playing roles. The most common uropathogen
is E coli, but unusual pathogens and fungal infections are more frequent among
patients with DM. Because patients with DM are considered to have complicated
UTI, and resistant uropathogens are a special concern, urine cultures should be
performed before and after therapy.
For the treatment of the
recurrent UTI, the treatment is not differ in patient with diabetes mellitus
and those who does not have because it totally depends on the uropathogens
itself. Through urine culture and sensitivity we can identify the pathogens and
the antibiotics suitable for treatment. But the duration may differ because we
have to consider that these patients as having a complicated UTI and therefore
to treat them for a period of 7–14 days. But, there are no clinical trials that
answer the question as to the optimal antimicrobial treatment strategy
(especially duration of treatment) in diabetic patients with a UTI.
Mdm HI was diagnosed with
diabetes mellitus 16 years ago. T2 Diabetes Mellitus is primarily due to
insulin resistance as well as deficiency. The insulin resistance state results in
increased hepatic glucose output, reduced utilisation of glucose by various
organs, increased renal reabsorption of glucose and reduced incretin hormones
production among others. Diabetes has a prevalence of 15.2% and 20.8% for
adults above the age of 18 and 30 years, respectively, in Malaysia by The National Health and
Morbidity Survey (NHMS) 2011. Unfortunately, 52% of those with diabetes above
the age of 18 years old were unaware of their diagnosis. In terms of diabetes
control, only 23.8% of patients in primary care and 12.7% in tertiary
institutions were able to achieve their specified glycaemic targets. And Mdm HI
is among those who do not achieve the glycaemic target.
Mdm HI, HbA1c was 10.8 % while
the target according to the Malaysian Clinical Practice Guidelines less than or
equal to 6.5 %. This is maybe due to the uncontrolled diet and sedentary
lifestyle she is having. Regarding the pharmacological approach, the dose of
the current medication she is taken was appropriate.
Mdm HI was diagnosed with hypertension and
dyslipidaemia 6 years ago. Her blood pressure at this visit was 151/84 mmHg and
he was asymptomatic. The doctor has explained to Mdm HI about his diagnosis and
causes of his illness.
The prevalence of hypertension in Malaysians
aged 18 years and above was 32.7% and for aged 30 years and above was 43.5% in
2011. Hypertension is a silent disease; the majority of cases (61%) in the
country remain undiagnosed. Untreated or sub-optimally controlled hypertension
leads to increased cardiovascular, cerebrovascular and renal morbidity and
Only 35% of Malaysian patients achieved
blood pressure control (<140/90 mmHg) while on treatment. Every effort should be made to achieve target blood pressure. Mdm HI needs to know the target for his blood pressure so that she knows how much she has missed the target. The target for hypertension with diabetes is less than 140 SBP and less than 80 mm/Hg for DBP. In addition, regarding the side effects of Perindopril; it is reported by at least 1% of patients taking it to have poor concentration, changes in weight, changes in sleep and decreased interest. Selection of effective and safe antihypertensive therapy for each individual is an important health-care priority. High BP can be treated with a wide range of antihypertensive agents from a number of different classes. These drugs may differ in their suitability for administration to different subpopulations of patients. Results from both clinical trials and postmarketing surveillance indicate that the angiotensin-converting enzyme (ACE) inhibitor perindopril erbumine is safe and well tolerated in a wide range of patients with hypertension. Cough, the most common ACE inhibitor-associated side effect, is also the most common clinical adverse event reported for perindopril, but <2% of perindopril-treated patients discontinue therapy because of cough. Other adverse events often associated with ACE inhibitors, first-dose hypotension and hyperkalemia, appear to occur less often with perindopril than with other agents in this class. The favorable safety profile for perindopril extends to a wide range of patients, including the elderly and those with either heart failure or renal disease. Perindopril has no negative effects on lipids in patients with hyperlipidemia or on glycemic control in patients with type 2 diabetes mellitus, and it reduces proteinuria in patients with renal disease. Perindopril has no known clinically significant drug-drug interactions. Thus, perindopril is a safe BP-lowering agent with documented tolerability in a wide range of patients with hypertension. In conclusion, in primary care clinics each patient's management should be individualised. It is also important to discuss the management so that patient's compliance and adherence can be maximised.