Parlez-en à votre pharmacien

July 15, 2021
Q:

I have noticed my boyfriend’s pee is foul smelling. I heard that pharmacists can prescribe antibiotics now. Can you dip his urine and treat him for an infection?

A:

A urinary tract infection (UTI) is defined as a bacterial infection of the urinary tract that can involve the lower urinary tract (i.e. cystitis or bladder infection) or upper urinary tract (pyelonepthritis or kidney infection) tract.

New Brunswick pharmacists can assess and treat several minor ailments including uncomplicated UTI of the lower urinary tract. An assessment for treatment involves a face-to-face appointment with the pharmacist to review your signs and symptoms. The purpose is to make sure that symptoms are in keeping with a simple bladder infection and that the likelihood of a more serious kidney infection is low. 

Signs and symptoms of an uncomplicated urinary tract infection (i.e., a simple cystitis or bladder infection) include dysuria, or painful urination, urinary frequency, a sense of urgency to urinate, or suprapubic tenderness. Symptom onset is usually less than three days. Indicators of a more serious infection that require a physician or nurse practitioner assessment may include the presence of fever, chills, lower back or flank pain, a longer duration of symptoms, patients with indwelling catheters, or chronic health conditions. Foul smelling urine is not a sign of urinary tract infection. Cloudy appearing urine also is not diagnostic of bladder infection. A urinalysis may be performed to rule out a urinary tract infection but it is not always necessary. While a negative urinalysis rules out urinary tract infection, a positive culture does not diagnose infection. 

Pharmacists do not assess urinary tract signs and symptoms in men, children, or pregnant women as these groups of people may have more complicated infections that require closer monitoring and follow up than can realistically be provided in a community pharmacy setting.

The presence of bacteria in the urine does not mean you have urinary tract infection. For every decade of life, we have approximately that percentage likelihood of having bacteria in our urine that is not causing infection (i.e., an 80-year-old female is about 80 per cent likely to have bacteria in the urine). We should not use antibiotics in this case but rather antibiotics should be saved for people who have signs and symptoms of infection. “Symptom free pee, let it be”. In this way we can be more confident that bacteria will not be resistant to antibiotics and that they will be active against bacteria when we are actually sick.

If an antimicrobial is indicated to treat your infection, a pharmacist can prescribe one as clinically appropriate based on your medication allergies, recent antimicrobial use in the last three months, any recent urinary culture and susceptibility results, and other factors.

Your pharmacist will also provide you with a monitoring plan with specific parameters so that you will know if your infection is resolving, if you are experiencing medication toxicity, and when to seek medical treatment.

New Brunswick pharmacists have been able to prescribe for uncomplicated urinary tract infections since 2014, but the service is not funded by Medicare when it is provided by a pharmacist. Patients must pay out of pocket to access pharmacist care for urinary tract infections; however, the New Brunswick government has committed to publicly-funding this service.

Once a person has the signs and symptoms of a urinary tract infection, antimicrobial treatment is generally required. Prevention is key to avoid multiple courses of unnecessary antimicrobials.  Good bathroom hygiene includes wiping well from front to back. Do not “hold it”. Use the washroom when you have the urge to urinate. Minimize caffeinated drinks, and ensure adequate daily water intake. It is recommended that adult women drink three liters of water per day.

D-mannose is a sugar that may prevent or reduce the incidence of urinary tract infections and may also increase the duration between infections in people who suffer from recurrent UTIs. Scientists believe it works by preventing bacteria from sticking to the walls of the urinary tract. Talk to your pharmacist about a specific product and dosing regimen for you. The usual dosage is 300 to 600 mg daily for prevention. A one-month supply is approximately $40.

Dr. Kevin Duplisea (PharmD BSc. Pharm, BSc. ACPR) is a pharmacist at Sharp’s Corner Drugstore in Sussex, New Brunswick. His opinions expressed in this newspaper are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment. Send your questions to AskYourNBPharmacist@gmail.com.