Underestimating an Infection

Farmacist.info is happy to welcome our 4th collaborator: Sabin Torcea

Sabin graduated pharmacy school in 2013 and since then has worked in 6 community pharmacies in the same company. He was promoted to Head Pharmacist in 2014 and had the privilege to manage a new community pharmacy opened in Mures county.

Today he will be presenting us with a memorable experience from which we all, pharmacists and patients, can learn something from.


A strange case

An infection is a serious business! It can lead to complications, serious sequelae or even life-threatining situations. 

I was working in a pharmacy near a small town hospital. I knew a part of the staff and we collaborated for some time. One day, one of the nurses that worked there, Mrs. Y, came to us to ask for our advice about her father’s (Mr. X.) health problem.

Mr. X, was suffering from an urinary tract infection (UTI), and after his first visit to his family physician, he was given a treatment that included a broad-spectrum antibiotic from the Cephalosporine class and Indomethacin for the pain. Because the symptoms did not show any signs of improvement, the patient was given another antibiotic from the Quinolone class (a new antibiotic with broad-spectrum activity), a type of drug which is used in cases where the microorganisms are resistant to cephalosporins.

Noticing the bad evolution of the patient’s health I advised Mrs. Y to take an urine sample and run an antibiogram*. Normally this should have been the first thing to do, but in this case, the protocol was ignored. During this time, Mr. X’s condition was deteriorating  and he was started on injectable Gentamicine and Ampiciline ( two antibiotics recommended in double teraphy for resistant bacteria).

After two days of injectable treatment, the patient’s health status was very bad. Mrs. Y returned to the pharmacy to inform us about the antiobiogram results. When we read the results, we couldn’t believe our eyes: Mr. X’s bacteria was resistant to all kinds of broad-spectrum antibiotics and ultra-broad-spectrum antibiotics, except Nitrofurantoin (a Imidazolidinedione antibiotic used to treat urinary tract infections). Nitrofurantoin has been available for the treatment of urinary tract infections since 1950 but in the beggining of the early 2000s it was considered outdated and the  recommendation for its use in urinary tract infections was limited.

After only one day of treatment with Nitrofurantoin the pacient showed signs of improvement, and, after 5 days of treatment, the pacient’s health status was significantly improved with no signs of bacterial infection.

Who would have thought that a medicine once considered outdated, could save someone’s life?

Irresponsible, irational and repetitive use of antibiotics without medical advice has led  to a significant increase in bacterial resistance and the treatment success rate is decreasing!

Protocols require the use of broad spectrum antibiotics, and the importance of sensitivity testing is still ignored!

What are the main symptoms of urinary infection?

  • Urgent need for urination
  • Burning or pain during urination
  • Fever, headache, chills

What to do in case of a urinary tract infection?

  • First you will need to consult with a specialist (family doctor, urologist, pharmacist)
  • It is recommended to take a urine sample for analysis to establish the identity of the pathogen agent and determine its sensitivity to a class of antibiotics
  • Consumption of at least 2L of liquid / day.
  • Avoid exposure to cold of lombar or pelvic areas, especially for women, who are more prone to urinary infections than men.

Sabin and the pharmacists,

*Antibiogram – the result of a laboratory testing for the sensitivity of an isolated bacterial strain to different antibiotics. It is by definition an in vitro-sensitivity.

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