PROSPECTIVE ANALYSIS OF PRISCRIPTION PATTERN OF ANTIMICROBIAL THERAPY FOR URINARY TRACT INFECTIONS IN PREGNANT FEMALE PATIENT

Abstract

Pregnancy is a state of relative immunocompromise. This immunocompromise may be another cause for the increased frequency of UTIs seen in pregnancy. UTIs are one of the most common medical complications of pregnancy. Urinary tract infections (UTI) in pregnancy are a large and under-emphasized risk factor for pregnancy morbidity and adverse birth outcomes in low- and middle-income country. A prospective, single centric, observational and descriptive type hospital based study was conducted at the Gynecology Department of a tertiary care hospital for a period of 9 months. This prospective analysis comprises the prevalence of UTI in 53 pregnant female patients with study of their antibiotic   prescription pattern. this present prospective study shows that the prevalence rate of urinary tract infection in pregnancy is 26.5%.(53 UTI cases out of screened 200 patients) Controversially, many literature reviewed showed that in pregnant women’s UTI incidence can be as high as 8 to 20%. Present study indicates the incidence of UTI in pregnancy in relation to gestation period shows that max. UTI patients are from second Trimester (55%) in comparison to first trimester (28%). Least rate of UTI incidence was in Third trimester (17%) due to clinical supervision of pregnant females from starting of gestation. Observation indicates incidence of UTI in relation to age groups under three gestation periods, max. UTI patients were under age group 21 to 30 years of all gestation periods. In first trimester, Second Trimester and third trimester there were 68%, 62% and 56% respectively UTI patients were under age group 21-30 years. This prevalence was due to physiological changes that occur majorly in second trimester. Incidence of UTI pregnant patients under age group <20 years was more in both 1st and 3rd trimester than under age group >30 years. These findings indicate that no relationship exists between age and incidence of UTI in pregnancy.
Urinary Tract Infections are confirmed on the basis of bacteriuria present. Urinary tract infections are generally uncomplicated in non pregnant females but becomes complicated in pregnancy specially when left untreated. Present study showed incidence of uncomplicated urithritis and cystitis (65%) and  No complicated UTI cases (pyelonephritis). Gestation distribution of uncomplicated UTI patients showed that max. urithritis(38%) was in
Present study shows the frequently isolated organism in UTI in pregnancy include species of Enterobacteriaceae especially Escherichia coli and others citrobactor and proteus. Klebsiella was the second (22%) most isolated organism. Cephalosporin’s with more than 90% general susceptibility than fluoroquinolones (<90%). Average general susceptibility was found with Ampicillin and sulphonamides.  fluoroquinolones was also alternative choices. All antibiotic prescription was based on antibiotic sensitivity to culture organism. Present study shows max UTI patients of 1st trimester received Nitrofurantoin (47%) as a monotherapy. Due to Antibiotic sensitivity to cultural organism, ciphalosporins and fluoroquinolones was also prescribed as monotherapy. Only single UTI pregnant patient shows sensitivity to cotrimoxazole in first trimester. Cotrimoxazole was prescribed with folic acid supplement. As a safe nonteratogenic drug nitrofurantoin was prescribed to max patients with others drugs in combination. Phenazopyridine an urinary analgesic also prescribed in max. number in combination with nitrofurantoin.
Data analysis of observation of 2nd trimester showed that higher percent distribution of patients were received Nitrofurantoin with other drug combinations. Max. no of patients (75%) received Nitrofurantoin with phenazopyridine in comparision to other urinary antibiotics. Patients with Vit.B12 deficiency were also receiving Nitofurantoin with folic acid supplement. Only single Hypertensive pregnant received Methyldopa with ciphalosporins. Only single case of gestational diabetes received nitrofurantoin with glibenclamide  with safer indication. Nitrofurantoin was again highly prescribed urinary antibiotic drug with other drug combination.
Present study revealed in 3rd trimester fluoroquinolones were better treatment options with other drugs combination. All pregnant female patients with or without Comorbid conditions received fluoroquinolones.
Keywords: fluoroquinolones, Nitrofurantoin