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Suggest Treatment For Recurrent UTI
Question: My XXXXXXX mother has chronic bladder utis - predominantly ecoli with enterococcus as a secondary organism.
She was on nitro for 2.5 years - uti free but developed liver enzymes which dropped
when it was stopped
Was on fosfomycin for a 1 year with one episode but new doctor only wanted estrogren last year
She had three ecoli episodes and treated
She was 4 months ecoli free with 1000mg vitamin c
But two weeks ago another high ecoli lab sample as she had incontinence, urgency and tingling upon urinating. Her eGFR was 65 in Dec. She was given macrobid for 10 days at 200mg daily. I checked the home urinalysis and it was negative
4 days later - she had another urine culture that showed high ecoli which was still sensitive to nitrofuran. Her wbcs were 500 and ethrocytes - 3
No antibiotic was given during the last week as her symptoms seemed to go away
with 1gram of mannose 3 times a day. Doctor did not wish to prescribe another antibiotic at the time as my mother was prescribed morphine for severe neurological pain due to spinal arthritis - introducing too many meds.
I am glad the mannose has helped
Even though she doesn't have the distinctive urinary symptoms - she is a bit more tired
I don't know if that's the remnants of the uti or her acute back pain robbing her energy.
I have urinalysis test strips but I don't think they are as accurate as the labs
I would like at least another lab urinalysis for wbcs to see if they have come down
Also she has had a few urine samples test for enterococcus where she had no symtoms. But her last treated episode - doctor chose an antibiotic to go atter both organisms. I think the enterococcus helps her against the ecoli
What are your overall thougts on this last episode and how it should be followed up
Please provide your experience/years in this facet of utis
She was on nitro for 2.5 years - uti free but developed liver enzymes which dropped
when it was stopped
Was on fosfomycin for a 1 year with one episode but new doctor only wanted estrogren last year
She had three ecoli episodes and treated
She was 4 months ecoli free with 1000mg vitamin c
But two weeks ago another high ecoli lab sample as she had incontinence, urgency and tingling upon urinating. Her eGFR was 65 in Dec. She was given macrobid for 10 days at 200mg daily. I checked the home urinalysis and it was negative
4 days later - she had another urine culture that showed high ecoli which was still sensitive to nitrofuran. Her wbcs were 500 and ethrocytes - 3
No antibiotic was given during the last week as her symptoms seemed to go away
with 1gram of mannose 3 times a day. Doctor did not wish to prescribe another antibiotic at the time as my mother was prescribed morphine for severe neurological pain due to spinal arthritis - introducing too many meds.
I am glad the mannose has helped
Even though she doesn't have the distinctive urinary symptoms - she is a bit more tired
I don't know if that's the remnants of the uti or her acute back pain robbing her energy.
I have urinalysis test strips but I don't think they are as accurate as the labs
I would like at least another lab urinalysis for wbcs to see if they have come down
Also she has had a few urine samples test for enterococcus where she had no symtoms. But her last treated episode - doctor chose an antibiotic to go atter both organisms. I think the enterococcus helps her against the ecoli
What are your overall thougts on this last episode and how it should be followed up
Please provide your experience/years in this facet of utis
Brief Answer:
recurrent UTI need not be treated each time with antibiotics.
Detailed Answer:
Hello XXXX and welcome to HCM.
As an Urologist, i can fully understand your concern.
It's good to clear this doubt.
At her age,UTI (URINARY INFECTION),should be diagnosed on urine culture only.
Unless she's having symptoms, like pain while passing urine or fever, you can leave the UTI alone, without any antibiotic.
She's had enough antibiotics already.
Complete the course of antibiotic started.
Ensure she drinks 8-10 glasses fluids daily,more in daytime.
If she's on other medication,kindly send the prescription with a scan of abdomen,if you have any other doubts.
Wish her well.
Dr.Matthew J. Mangat.
recurrent UTI need not be treated each time with antibiotics.
Detailed Answer:
Hello XXXX and welcome to HCM.
As an Urologist, i can fully understand your concern.
It's good to clear this doubt.
At her age,UTI (URINARY INFECTION),should be diagnosed on urine culture only.
Unless she's having symptoms, like pain while passing urine or fever, you can leave the UTI alone, without any antibiotic.
She's had enough antibiotics already.
Complete the course of antibiotic started.
Ensure she drinks 8-10 glasses fluids daily,more in daytime.
If she's on other medication,kindly send the prescription with a scan of abdomen,if you have any other doubts.
Wish her well.
Dr.Matthew J. Mangat.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr M
Do you understand - she had another ecoli incident about 2 weeks ago.
She had incontinence/urgency/tingling that did not go away within 5 days
regardless of the vitamin c.
The urine culture had a high ecoli count.
She took 10 days nitro and by day 10 - the urinalysis was negative
for wbcs, rbcs and nitrates.
4 days after - she again a lab confirmed ecoli (greater than 100*e6) and sensitive to nitro. Her symptoms seem to have resided thats because I introduced the mannose at the time for a preventative
I woud still think if she has high wbcs (500) as she did this past week with the 2nd ecoli infection that it takes energy out of her.
She has enough health issues now with her spinal arthritis.
Also for a XXXXXXX to drink 2Litres of water is unrealistic
I dont mean to give another antibiotic but shouldnt another lab sample be taken to see if the wbcs are down - 500 is high - is it not?
Do you understand - she had another ecoli incident about 2 weeks ago.
She had incontinence/urgency/tingling that did not go away within 5 days
regardless of the vitamin c.
The urine culture had a high ecoli count.
She took 10 days nitro and by day 10 - the urinalysis was negative
for wbcs, rbcs and nitrates.
4 days after - she again a lab confirmed ecoli (greater than 100*e6) and sensitive to nitro. Her symptoms seem to have resided thats because I introduced the mannose at the time for a preventative
I woud still think if she has high wbcs (500) as she did this past week with the 2nd ecoli infection that it takes energy out of her.
She has enough health issues now with her spinal arthritis.
Also for a XXXXXXX to drink 2Litres of water is unrealistic
I dont mean to give another antibiotic but shouldnt another lab sample be taken to see if the wbcs are down - 500 is high - is it not?
Brief Answer:
Ciprofloxacin is very effective in recurrent UTI.
Detailed Answer:
Hello XXXX,
Your XXXXXXX mother is relatively free of urinary symptoms.
We tend to ignore UTI in such cases, unless they're symptomatic or diabetic.
Her main health issue is spinal arthritis, which needs morphine,as you report.
That will make her quite drowsy,as a side effect.
An adult needs 8-10 glasses fluids daily, including water,tea,coffee,juices,etc.
If that is not met, she's likely to get more problems,due to dehydration.
1 litre =5 glasses of a standard glass of 200ml.
Dehydration also leads to recurrent infection.
If another antibiotic is given,Ciprofloxacin is very effective in such people.
Hope your doubts are cleared.
Wishing her a speedy recovery.
Dr,Matthew J. Mangat.
Ciprofloxacin is very effective in recurrent UTI.
Detailed Answer:
Hello XXXX,
Your XXXXXXX mother is relatively free of urinary symptoms.
We tend to ignore UTI in such cases, unless they're symptomatic or diabetic.
Her main health issue is spinal arthritis, which needs morphine,as you report.
That will make her quite drowsy,as a side effect.
An adult needs 8-10 glasses fluids daily, including water,tea,coffee,juices,etc.
If that is not met, she's likely to get more problems,due to dehydration.
1 litre =5 glasses of a standard glass of 200ml.
Dehydration also leads to recurrent infection.
If another antibiotic is given,Ciprofloxacin is very effective in such people.
Hope your doubts are cleared.
Wishing her a speedy recovery.
Dr,Matthew J. Mangat.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Its been 5 years now with these utis.
The nitrofuran should have gotten rid of it.
It appears the mannose sugar 1gram three times a day has made her asymptomatic at this point. If her wbcs are in check - that would mean the body is not fighting anything more
The nitrofuran should have gotten rid of it.
It appears the mannose sugar 1gram three times a day has made her asymptomatic at this point. If her wbcs are in check - that would mean the body is not fighting anything more
Brief Answer:
recurrent UTI is a common situation.
Detailed Answer:
Hi XXXX,
In recurrent UTI in elderly,Urologists take care to treat the significant one's only.
There's no need to keep checking the urine off and on.
It's not the wbc's, but the positive urine cultures, that need to be treated.
Drinking adequate fluids daily is essential.
If at all,you've any doubts,feel free to clear them with me.
Wishing your mother well.
Dr.Matthew J. Mangat.
recurrent UTI is a common situation.
Detailed Answer:
Hi XXXX,
In recurrent UTI in elderly,Urologists take care to treat the significant one's only.
There's no need to keep checking the urine off and on.
It's not the wbc's, but the positive urine cultures, that need to be treated.
Drinking adequate fluids daily is essential.
If at all,you've any doubts,feel free to clear them with me.
Wishing your mother well.
Dr.Matthew J. Mangat.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I can see if a person has nitrites in their urine - and no symptoms -not a big deal
But if they have high wbcs - 500 vs 5, this means the body is trying to rid itself of a bacterium that is problematic
I think you are wrong on that.
Even if you find ecoli etc in the urine culture and they are higher numbers with no symptoms - that isn't a concern as perhaps a benign colonization
I think you completely wrong on this
But if they have high wbcs - 500 vs 5, this means the body is trying to rid itself of a bacterium that is problematic
I think you are wrong on that.
Even if you find ecoli etc in the urine culture and they are higher numbers with no symptoms - that isn't a concern as perhaps a benign colonization
I think you completely wrong on this
Brief Answer:
specialists rely on colony cultures only, for diagnosis.
Detailed Answer:
Hi XXXX,
Nitrites in urine, is not the same as UTI.
Only a culture is specific for infection.
urine showing 500 wbc's, is not a commonly seen report.
You can get it rechecked, at another standard lab.
Anyway, all Urologists rely on urine cultures only, to diagnose and treat UTI.
There's no benign colonization.
Colony counts above 1 lac/ml, is considered as UTI.
Hope your doubts are cleared.
Wishing your mother good health.
Dr.Matthew J. Mangat.
specialists rely on colony cultures only, for diagnosis.
Detailed Answer:
Hi XXXX,
Nitrites in urine, is not the same as UTI.
Only a culture is specific for infection.
urine showing 500 wbc's, is not a commonly seen report.
You can get it rechecked, at another standard lab.
Anyway, all Urologists rely on urine cultures only, to diagnose and treat UTI.
There's no benign colonization.
Colony counts above 1 lac/ml, is considered as UTI.
Hope your doubts are cleared.
Wishing your mother good health.
Dr.Matthew J. Mangat.
Above answer was peer-reviewed by :
Dr. Prasad
Dr M
I can see you have a bedside manner with your last sentence but we differ on the methodology of what constitutes an infection from North XXXXXXX to XXXXXXX
There are many elderly women that habour ecoli which they have no symptoms
but the wbcs is the indicator if in fact the body finds it to be harmful
I have seen other the last week doing the urinalysis dip tests
The wbcs and rbcs dropping but the nitrites means ecoli is still within.
My mother is an acute pain due to spinal arthritis and I don't wish any more meds
Mannose sugar out of fluke has helped her
I can see you have a bedside manner with your last sentence but we differ on the methodology of what constitutes an infection from North XXXXXXX to XXXXXXX
There are many elderly women that habour ecoli which they have no symptoms
but the wbcs is the indicator if in fact the body finds it to be harmful
I have seen other the last week doing the urinalysis dip tests
The wbcs and rbcs dropping but the nitrites means ecoli is still within.
My mother is an acute pain due to spinal arthritis and I don't wish any more meds
Mannose sugar out of fluke has helped her
Brief Answer:
nitrites or dip stick tests, aren't confirmatory of UTI.
Detailed Answer:
Hi XXXX,
Good to see your feedback.
As an Urologist, we have a scientific consensus, for all treatment worldwide.
Kindly try to understand that, nitrites are non-specific. Same with dip stick test.
It's only suggestive, of a possible infection.
More or less, the same with wbc's. It's presence isn't confirmatory of UTI.
These are principles applicable in U.S.A., or anywhere across the world.
Mannose isn't the primary treatment in UTI.
Hope you're now clear of your doubts.
You can confirm with your Urologist or physician, when you meet them next.
Wishing your mother well.
Dr.Matthew J. Managt.
nitrites or dip stick tests, aren't confirmatory of UTI.
Detailed Answer:
Hi XXXX,
Good to see your feedback.
As an Urologist, we have a scientific consensus, for all treatment worldwide.
Kindly try to understand that, nitrites are non-specific. Same with dip stick test.
It's only suggestive, of a possible infection.
More or less, the same with wbc's. It's presence isn't confirmatory of UTI.
These are principles applicable in U.S.A., or anywhere across the world.
Mannose isn't the primary treatment in UTI.
Hope you're now clear of your doubts.
You can confirm with your Urologist or physician, when you meet them next.
Wishing your mother well.
Dr.Matthew J. Managt.
Above answer was peer-reviewed by :
Dr. Sonia Raina
I understand your rationale in not treating minor utis.
I don't agree with the wbcs etc but anyhow.
So I spent yesterday 5 hours at the local ER hoping to get an MIR for her acute hip pain. Nothing meaningful or a pain reliever either.
They did a urine check and stated my mother had a uti.
We declined the antibiotic cipro as she had no symptoms.
My mother didn't drink much yesterday and not the mannose sugar.
Today - when I did the urinalysis test strips - they were high for rbcs and wbcs
She was incontinent three times in 3 hours and had a low grade fever
37.5 vs normal body temperature of 36.4
So I got the cipro for her - 500mg twice a day for 5 days.
I would have preferred the 1 time fosfomycin as its simpler.
She now has to battle acute hip pain and yet another urinary infection.
I hope its not a kidney infection.
As I mentioned she ended a course of nitro for 10 days and 4 days later beginning of another uti - she is not doing well
Goodnight
Why you stated cipro is very good for reoccurent utis?
I don't agree with the wbcs etc but anyhow.
So I spent yesterday 5 hours at the local ER hoping to get an MIR for her acute hip pain. Nothing meaningful or a pain reliever either.
They did a urine check and stated my mother had a uti.
We declined the antibiotic cipro as she had no symptoms.
My mother didn't drink much yesterday and not the mannose sugar.
Today - when I did the urinalysis test strips - they were high for rbcs and wbcs
She was incontinent three times in 3 hours and had a low grade fever
37.5 vs normal body temperature of 36.4
So I got the cipro for her - 500mg twice a day for 5 days.
I would have preferred the 1 time fosfomycin as its simpler.
She now has to battle acute hip pain and yet another urinary infection.
I hope its not a kidney infection.
As I mentioned she ended a course of nitro for 10 days and 4 days later beginning of another uti - she is not doing well
Goodnight
Why you stated cipro is very good for reoccurent utis?
Brief Answer:
Ciprofloxacin is widely used in UTI, with good response.
Detailed Answer:
Hi XXXX,
As i had mentioned, if symptomatic UTI is present, it should be treated.
So with fever, she must receive antibiotic, preferrably according to culture report.
If she's not had an ultrasound scan-KUB, she must've that also.
That will also help rule out kidney and bladder changes.
Ciprofloxacin is a safe and very effective in UTI's.
Most people get very good response.
Her fever should come down quickly.
Hope her spinal pain is under control.
Wishing her well.
Dr.Matthew J. Mangat.
Ciprofloxacin is widely used in UTI, with good response.
Detailed Answer:
Hi XXXX,
As i had mentioned, if symptomatic UTI is present, it should be treated.
So with fever, she must receive antibiotic, preferrably according to culture report.
If she's not had an ultrasound scan-KUB, she must've that also.
That will also help rule out kidney and bladder changes.
Ciprofloxacin is a safe and very effective in UTI's.
Most people get very good response.
Her fever should come down quickly.
Hope her spinal pain is under control.
Wishing her well.
Dr.Matthew J. Mangat.
Note: Consult a Urologist online for consultation about prostate and bladder problems, sexual dysfunction, kidney stones, prostate enlargement, urinary incontinence, impotence and erectile dysfunction - Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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