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Family Physician

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How can tenderness in the back and urethra be treated despite taking Amoxicillin and Levofloxacin?

Answered by
Dr. Bonnie Berger-Durnbaugh

General & Family Physician

Practicing since :1991

Answered : 2850 Questions

Posted on Mon, 4 Jun 2018 in Urinary and Bladder Problems
Question: I have been experiencing UTI symptoms - tenderness in urethea, lower back kidney area tenderness, no fever - for a couple of days. I am enrolled in Kaiser Permanente which in this small California county, Sonoma, requires patients go to the emergency room which is also urgent care for this area. I am 70 years old, have mild episodic MS, and am fearful of entering such a germ laden area as the flu season is so rampant that hospital beds are unavailable in the county. Have been self treating with probiotics, advil, cranberry capsules, vit C, and lots of water. After 2 full days I am still tender in the back kidney area and am contemplating some old meds - amoxicillin (but I may be allergic to penecillins) and levofloxacin.
What do you suggest? --Cindy
Answered by Dr. Bonnie Berger-Durnbaugh 3 hours later
Brief Answer:
Some suggestions

Detailed Answer:

I do understand your not wanting to go in to the ER with all of it's infectious germs. But given all of what you wrote, I think with some precautions the benefits of going in would outweigh the risks.

Amoxicillin will not help a urinary tract infection even if it is still potent. The levoflaxacin might, but it's category of antibiotics (including Cipro) now carries a black box warning because of some significant side effects.

The other reason to go in is because it would be wise to have the urine cultured and a sensitivity to antibiotics test done. I am not doubting that you have a UTI. But a culture and sensitivity test will show what antibiotics are most effective for your infection. They will start you on an antibiotic and then in a couple of days you should call to make sure the bacteria that is growing on the culture is fully sensitive (not partially sensitive/partially resistant aka "intermediate") to whatever antibiotic they give you (which might be trimethoprim/sulfamethoxazole aka Bactrim or Septra; or cephalexin aka Keflex).

Finally, I think it is important to go in because lower uncomplicated UTIs that are localized in the bladder do not usually give flank pain, so it's possible there is a bit of kidney infection brewing. This would alter the choice of antibiotic and duration for taking it.

Now - how to go in and not get sicker. The main way germs enter our bodies is by our touching our nose, eyes, or mouth with our hands after touching a contaminated surface. Respiratory infections come in primarily through touching our eyes or nose. Gastrointestinal infections primarily by touching our mouth. So absolutely do not touch your face at all until you come home, and then wash your hands with regular soap and water for several minutes. Then alcohol gel your hands if you have some. If you bring and use a cell phone or anything else in the ER, wipe those down with rubbing alcohol.

When you get to the ER, ask them for a mask for you to wear. Explain that you have MS and must not put yourself at risk of infection.

When staff come in to examine you or draw blood, be assertive and ask them to alcohol gel their hands in front of you. They may say they just did outside the room. Ask them to do it again, that you are very fearful of infection given that you have MS. They won't argue, they will just grab some gel and do it.

If this still seems too risky (and I understand), call the doctor on call for your own doctor and tell them the situation. They may just phone in a prescription for you. Usually you can reach the doctor on call by just calling the phone number for your own doctor. The answering service will then connect you with the on-call doctor.

If you are willing, please let me know what you do.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Bonnie Berger-Durnbaugh 6 hours later
Thank you for your answer. I know a test would yield a more directed antibiotic, but am very concerned about possible contagious consequences which would be hard to get treated in our currently overloaded hospital system.

I saw all of this firsthand while spending many weeks in the hospital with my husband who had a rare lymphoma and no white cells. Even with his precarious condition, the hospital had trouble keeping him in isolation with no hospital beds available for many hours each time he went in. It was a madhouse just about this time last year and no beds in 3 counties here. Same thing now.

I live in a small town 30 minutes from the Kaiser hospital system and cannot drive myself to Kaiser at the present time. And I would have to get a ride back to get a prescription as Kaiser only uses its pharmacies located 30 min away.

Neither pharmacy in town would be open after 6 pm so I elected to start AZO in the 4 hnours before before you had replied. I was hoping today for a prescription from you to fill locally. I am already feeling better than the last 2 days. Tonight I will split the one large dose, 750 mg, of levofloxacin taking half for 2 days. Your website states it is good for UTI, bladder and kidney infections.

My choice is based on factors such as multiple exposures to the flu/cold strains both in emergency, in a $95 public cab ride each way, and the long lines at Kaiser pharmacies standing among hordes hacking and coughing.

I know the protocol to protect myself, but feel repeated exposures over long hours is not a good option right now. I live alone. Where would I go if I contracted the flu/cold stuff and there are no hospital beds in 3 counties right now?

Answered by Dr. Bonnie Berger-Durnbaugh 6 minutes later
Brief Answer:
Thoughts on this

Detailed Answer:
Yikes - I did not realize flu was so wide spread where you live that 3 counties are affected to that extent.

I can understand your choice and yes, levofloxacin would work for most UTIs. I hope what you have in the house is not too out of date.

For the future, just so you know, we are not allowed to prescribe anything on this website. We only provide medical information and answer questions.

Watch for fever, nausea, or increasing flank pain, as those are signs that the infection may be establishing in your kidneys or entering your blood. In those cases, you really do have to go in as the risks of not doing so will outweigh the benefits.

I hope you are feeling much better soon.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Bonnie Berger-Durnbaugh 1 hour later
Thank you for your followup. The levofloxacin was prescribed XXXXXXX this year. I understand the gravity of worsening symptoms and and am ready to go to emergency if I spike a fever or have worse kidney area pain.

My husband died May 30 this year at age of 61. Two weeks before he was a candidate for bone marrow transplant by Standford, then he caught a UTI which killed him due to an 80-lb weight loss and no immune system to respond to the UTI.

Things change quickly with infections. I have learned my lessons the hard way.

Thanks again for caring and following up!

Answered by Dr. Bonnie Berger-Durnbaugh 15 hours later
Brief Answer:

Detailed Answer:

I looked up and found that the 500 mg film coated tablets of Levofloxacin have a shelf life of 3 yrs. I don't know if that is what you have, but if it is film coated it has a long shelf life!

Treatment for complicated cystitis (where the infection may have extended beyond the bladder - such as if there is flank pain) with levofloxacin is:

-For 10-day regimen: 250 mg orally or IV every 24 hours for 10 days
-For 5-day regimen: 750 mg orally or IV every 24 hours for 5 days

I am so sorry that your husband passed away and really May isn't so many months ago. How terribly hard.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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