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56 CPD ACTIVITY FROM PAGE 55 Cranberry and D-mannose Cranberry was thought to inhibit bacterial adhesion to the ureteral lining and assist in the prevention of symptomatic UTI. To date, however, no robust large studies have supported these claims. Therefore, cranberry supplementation for UTI prevention is not yet recommended.22 Similarly, the naturally occurring sugar D-mannose is proposed to inhibit bacterial adhesion and assist in the prevention of UTI. Limited studies are currently available to confirm this claim. Adverse effects such as diarrhoea and bloating have been observed.23 Probiotics Current research is unable to confirm or rule out the impact of prophylactic probiotics on prevention of recurrent UTI. No serious adverse effects appear to be attributed to taking probiotics.21 Currently, the RACGP guidelines for treatment of UTIs in ACFs do not support the use of intravaginal hormones, cranberry, Summary UTIs in the elderly have the potential to cause significant burden for both the patient and the healthcare system. Treatment for UTIs in older patients is currently based on guidelines for younger populations, although more evidence for treatment of UTI in older groups is emerging. Prevention of recurrent UTI with non- pharmacological treatment options is an area of growing research. However, research is yet to produce concrete recommendations. Communicating information to older people requires additional consideration to prevent medicine misadventure. References available on request. Accreditation Number: A2103RP1. This activity has been accredited for 1 hour of Group 1 CPD (or 1 CPD credit) suitable for inclusion in an individual pharmacist’s CPD plan, which can be converted to 1 hour of Group 2 CPD (or 2 CPD credits) upon successful completion of relevant assessment activities. 1. Which of the following cases could be considered an uncomplicated urinary tract infection (UTI)? A) First case of UTI in a 64-year-old otherwise healthy male. B) UTI in a 70-year-old woman with diabetes. C) UTI in a 54-year-old woman with a history of UTI nine months prior. D) UTI in a 60-year-old woman with an indwelling catheter. 2. Carla is a 65-year-old woman living in assisted living. Which of the following risk factors for UTI is likely to be relevant to Carla? A) Incontinence. B) Reduced mobility. C) Previous history of UTI. D) All these are likely to be relevant to Carla. 3. Maryanne is a 70-year-old female with no other health conditions. She is experiencing dysuria with her first UTI. She has no known allergies. Which of the following antibiotic regimens do guidelines recommend for Maryanne in the first instance? A) Amoxicillin 500mg every eight hours for five days. B) Trimethoprim 300mg daily for 10 days. C) Cephalexin 500mg twice daily for five days. D) Trimethoprim daily for three days. 4. Karl is a 59-year-old male diagnosed with a UTI. Bacterial prostatitis has been excluded and Karl has no allergies or other medical conditions. What would be the MOST APPROPRIATE antibiotic regimen for Karl? A) Trimethoprim 300mg daily for seven days. B) Amoxicillin/clavulanic acid 500/125mg twice daily for five days. C) Norfloxacin 400mg twice daily for 14 days. D) Amoxicillin 500mg twice daily for seven days. 5. A dosage administration aid patient of your pharmacy, 51-year- old Lynne has been prescribed nitrofurantoin 50mg daily for UTI. Lynne has a penicillin allergy. Which of the following would you discuss with Lynne? A) Nitrofurantoin can be taken daily to prevent your UTI. Has your doctor asked you to come back for reassessment at some stage? B) Nitrofurantoin is best taken at night so it will be packed in your dinner blister. C) Nitrofurantoin should be taken with food. D) All these points should be discussed with Lynne. Urinary tract infections in the elderly: how age changes management approach 2 CPD CREDITS In a community setting, elderly patients and their carers should be presented D-mannose or probiotics in prevention of UTI. 20 with current available evidence for prevention strategies. Where there is no risk of harm, patients may be willing to trial non- pharmacological strategies to see if they can provide benefit on an individual level. Communicating and counselling with elderly patients Communicating essential health information to elderly patients can have barriers, including health literacy, cognition, delirium and hearing difficulty. Medication review pharmacists may find screening tools helpful when assessing patients for cognitive fitness or delirium. The 4AT score is used for delirium. The MMSE and RUDAS tools may be used to assess patients for cognitive decline or the AD8 tool for carers and family members.24 Applying such tools may be difficult within the pharmacy, due to the time-limited nature of standard consultation. Therefore, patients of concern should be referred to their treating physician. Involving a family member or carer in counselling consultations may also be beneficial to ensure the patient can take medicines safely. Health literacy and hearing difficulty can be assessed by asking the patient to summarise the information provided in their own words. This will allow misunderstanding to be addressed prior to patients taking medicines and hopefully prevent medicine-related harm. RETAIL PHARMACY • MAR 2021