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Suggest treatment for E. coli ESBL in urine

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General & Family Physician
Practicing since : 2009
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Dear Doctor, I am a healthy 34 year old male with no major disease, I am living in Sweden with my family, a two months ago, i was in XXXXXXX for a month and then after returning to sweden after a month got a UTI with fever and severe body pains, I went to the doctor and he gave me mecillinam 3 times a day for 5 days. After the course is completed i got a symptoms back again after 2 days and went to the doctor again who did a urine culture test, until the culture result came i was put on Cefixime 200mg two times a day for 4 days, Yesterday the result came and it says E.coli ESBL>E5 CFU/ml. My doctor now put me on nitrofurantoin for 5 days 3 times a day. He said to use it for 5 days and come back if the symptoms doesnt go away. The urine culture report said Nitrofurantoin - S
I did some googling and found that this virus is antibiotic resistant and it made me worrying, i have my wife and 15 month old son living with me which is causing concerns.
My question is can the antiobiotics completely remove this ESBL from the body? if not if ESBL exists in the body will i get frequent infections or Can i live normally? Will it cause any further complications in the future? i also found that people with poor immune systems have this issue, if i practice a healthy lifestyle and if my immune system gets better, will ESBL dissappear from mybody?

I am feeling nervous and would appreciate your quick response.
Posted Tue, 26 Aug 2014 in Infections
 
 
Answered by Dr. Shoaib Khan 2 hours later
Brief Answer:
EBSL resistant to penicillins &cephalosporins only

Detailed Answer:
Hello sir and welcome.

Thank you for writing to us.

I have gone through your query and would like you to know that I am here to help.

I understand your anxiety sir, and would like to help clear all the queries you have. First of all, E. coli ESBL (extended-spectrum Beta-Lactamases) are a new class which have been found to be resistant to penicillins and cephalosporins (groups of antibiotics), which is why you did not response well to mecillinam (belongs to the group - penicillins) and cefixime (belongs to the group: cephalosporins).

The currently prescribed nitrofurantoin does not belong to either of these antibiotic groups and is also found to be sensitive (Nitrofurantoin - S) in your case, which means you will respond well to this medication. Take the medication as prescribed by your doctor, and this will surely help you sir, do not worry.

Yes, of course it is possible to completely remove ESBL from your body with the right antibiotic, which could be nitrofurantoin in your case. As long as the ESBL is present in your body, the infection will persist, but do not worry; by using the right antibiotic the infection will surely be treated a 100 % sir. Yes sir, you will be able to live a normal life once the infection is adequately addressed.

No sir, it will not cause any complications in the future and you will recover a 100 %. Yes, it is true that immunocompromised individuals do inherit this infection, and so living a healthy lifestyle will certainly help prevent all such infections in the future.

I hope you find my response helpful sir. It is just a matter of time (a few days), and you shall be completely healthy and fit once again sir. Do not worry. Please also feel free to write back to me for any further clarifications, I would be more than happy to help you.

Best wishes.
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Follow-up: Suggest treatment for E. coli ESBL in urine 1 hour later
Dear Shoaib, YOU ARE AN ANGEL! Really appreciate your quick response and thanks alot you have removed most of my anxiety. I clearly understood with your explanation of how this bacteria works and how we can get rid of it, which is not clearly explained on the internet and which caused me alot of panic

I have few more questions if you can help me understand, Does this mean that Cefixime will no longer work for me for example i get some other infection not related to UTI and ESBL in the future, i mean am i now completely resistant to the list of antibiotics mentioned in my culture report? i started with nitrofurotoin today, but till yesterday i was on cefixime 200 mg twice daily for 4 days and it controlled the infection alot (i had little urge to urinate and no urine burning at all during this time).

So i assume my infection is already reduced and with Nitrofurotoin, it will be removed completely. Also here in Sweden the doctor who looked at me said he never encountered such case except for in hospitals which made me worrying, they have a isolation ward for such patients, is this common in XXXXXXX i mean have you personally seen any cases ? if my infection does not go down will isolation the only solution? and for how many days?

I am using alcohol based gels while coming out of toilet and in general to rub my hands, is there any other way to ensure hygenie because i live with my wife and my 15 month old son in sweden.

Would greatly appreciate if you can answer these
 
 
Answered by Dr. Shoaib Khan 11 minutes later
Brief Answer:
It was my pleasure entirely sir

Detailed Answer:
Hello once again sir.

Thank you for your kind words, and I shall surely help you further sir.

No sir, cefixime will certainly work in the future as only the current bacteria causing the infection in your specific case is resistant to penicillin and cephalosporin group of antibiotics.

But if you (god forbid) get another ESBL infection in the future, cefixime and all other cephalosporins and penicillins will certainly not help to treat the infection. No sir, the current culture report shows what the bacteria is resistant to.

I am sure nitrofurantoin should also greatly help in providing a safe and rapid recovery.

The reason why your doctor said that is because ESBL is usually a hospital infection, which means individuals who are admitted in the hospital (with a low immunity already) usually get this infection, and not other individuals residing outside. But do not worry about this too much, as it can happen.

It is common in XXXXXXX as well, but as I mentioned sir, it is usually a hospital-bound infection. But some individuals belonging to less fortunate regions of the country also contract this infection. Yes sir, I have seen a few cases (may be 2 or 3) in my practice, they were all bed-ridden terminal patients sir.

In my opinion, isolation is only so you do not transmit this infection to others by sexual contact or by means of poor hygiene. But as you are aware about the requirement for good hygiene and are also on a course of effective antibiotics, isolation will not be required. So if at all you do not respond to the current medication, a change in antibiotics would be required and not isolation.

This along with regular showers, abstinence from all forms of sexual contact with your wife. Making sure your clothes are washed separately and not in a general load, and all other measures to ensure good hygiene will be required sir, nothing more.

I hope I have explained everything in a manner best understood by you sir. Please do not hesitate to write to me about anything, I am always available to help.

Best wishes.
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Follow-up: Suggest treatment for E. coli ESBL in urine 1 hour later
Dear Shoaib, It was nice speaking to you and knowing you, i am really happy with the way you have explained my queries, I think doctors like you cure patients not only the illness but also their mental anxiety.

just out of curiosity i am writing few more questions before i can close this discussion.

From the last two weeks, from the time i had the infection till it was detected today, i was washing all our clothes in the same load in the washing machine which washes in mild heat, then i dry them at 30C in the tumble dryer, i was washing my hands with Dove hand gel after i use the toilet, also i was feeding my son sometimes with a spoon (mostly bottled child food which we get in sweden). Does this put in any risk of exposure for my familiy? My main concern is about them.

Also i am writing the list of antibiotics listed in my urine culture report for you to evaluate and understand my case better.

Mecillinam - S
Ampicillin - R
Piperacillin Tazobactum - I
Cefadroxil - R
Ceftibuten - R
Trimetoprim - S
Trmetoprim Sulfa - S
Nitrofurantoin - S
Cefotaxim - R
Ceftazidim - R
Gentamicin - S
Ciprofloaxacin - R

Also is it common for an individual like me who haven't been admitted in the hospital or had any other desease to get this kind of bacteria? As far as i remember i used Heracillin twice or thrice (i week to 10 days in duration given by the doctor) in the last 2 years because i got some skin absceess)
 
 
Answered by Dr. Shoaib Khan 35 minutes later
Brief Answer:
All queries addressed

Detailed Answer:
Hello once again sir.

Thank you so much for your appreciation, my patient's appreciating all the help they get from me. I do not think the given scenario would have caused any problems sir.

This culture report proves that nitrofurantoin should help sir. If not, we will know which antibiotics can help.

It happens sometimes sir, you must have been in an immunocompromised state at sometime and have contracted the infection. Do not worry about it sir. Heracillin effectively treated you skin infection? If it was, that also proves that you are not resistant to penicillins. I hope this all makes sense to you now sir.

I am more than happy to be of assistance to you. Please do not hesitate to write to me anytime in the future sir. Here is my direct link: http://doctor.healthcaremagic.com/doctors/dr-shoaib-khan/64581.

God bless you.
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Follow-up: Suggest treatment for E. coli ESBL in urine 1 hour later
Dear Shoaib, Thanks for the link, now i know whom to ask in the future for any health related question and get the best answer.

I have one general question, before contacting you, as i said i was reading alot of articles on the internet which talked abt e.coli esbl, most of them wrote that it causes UTI first and then sometimes sepsis, My question is how long will it take for any UTI to become dangerous and cause sepsis ? i understand those are untreated cases, but since i read too much, just wanted to know.

Also does this infection spread through urine or human feces?
 
 
Answered by Dr. Shoaib Khan 3 hours later
Brief Answer:
Wishing you a speedy recovery sir

Detailed Answer:
Hello once again sir.

Cases which have had the infection for a long duration, and the bacteria only spreads without being treated for a duration of months (approximately 3 months or more) can lead to beginning of sepsis sir. The duration is not fixed and can vary from person to person depending on a number of factors like immunity, hygiene, etc.

The bacteria is usually colonized in the large bowel, and spreads through unhygienic hands used to clean after passing a bowel movement sir.

I hope I have explained this well enough sir. I understand your anxiety, but do not worry. You have been on antibiotics long enough to help prevent the spread to your family. Also remember sir, not everything you read online is true.

Best of luck and god bless sir.
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Follow-up: Suggest treatment for E. coli ESBL in urine 5 days later
Dear Doctor Shaoib,

Hope you are doing great and in good spirits, I wanted to continue our previous thread's discussion and wanted to give you an update on my infection and had few more doubts

I have finished my 5 days course of Nitrofurantoin 3 times a day (50 mg), Now its my second day after i finished my antibiotics course and i am feeling better, first question should i get a urine culture done to check if my esbl is gone completely or shall i wait for few more days (my gp here said wait atleast 10, but i strongly believe in your opinion)?

Also i forgot to mention, after i started taking the mecillinam antibiotic 2 weeks back (first round of therapy), i had urethral itching and some itching inside anus, is this due to the use of antibiotics or any yeast infections? Now i sometimes have this itchy feeling inside my anus, urethra but very mild even after i stopped taking all antibiotics? it only happens after i have a bowel movement or pass urine. Otherwise i am fine.

Bottom line is except for this slight itching i dont have the smelly urine which i had when i had the ecoli esbl in my urine.

the last question is you have mentioned in our discussion earlier that e.coli esbl is resistant to penicillins &cephalosporins, however if you see my culture report it says the virus is susceptible mecillinam and few other penicillins &cephalosporins.

Does this mean that my ESBL is not completely resistant to penicillins &cephalosporins? Would appreciate if you can help me understand.

Sorry for the long list of questions but i find it more useful when you explain me things than my own GP here in sweden
 
 
Answered by Dr. Shoaib Khan 23 hours later
Brief Answer:
Great to know you are doing better

Detailed Answer:
Hello once again sir and my sincere apologies for the delay as I was travelling and was in transit for quite some time.

Without further ado, let me get right to answering your queries. First of all see, in my experience each patient is different and each infection has its varying degrees. One patient with ESBL may require a 5 day antibiotic course and recover completely, while the other may require a 7- or 10-day course as either his/her immunity was low, or the infection was stronger, etc. So the first thing required was for your doctor to examine you before the last dose of the antibiotics to make sure you do not require a continuation of your antibiotic course.

Either way, now that you have completed the course, the urine culture can be conducted within 2-3 days after the last dose of antibiotics as the medication does not stay in the system longer than this and thus will not be effective for longer than this, which means waiting and getting the culture at a later period of time does not really help. You can go ahead with a culture anytime after 3 days of the last dose. This also helps on preventing a delay in treatment, if at all the infection has not subsided.

As for the itching, if you remember I had earlier mentioned to you that the ESBL resides in the large colon, the itching could purely be because of that. But if at all the itching in and around your urethra does not subside with time, this could be a sign (not confirmed) of a resident infection sir.

As for your last question sir, if the culture has reported susceptibility to some penicillins and cephalosporins then it must be true. But generally as a rule, once ESBL is diagnosed we prefer avoiding these medications in order to not waste time with treatment.

It has been a while since I heard from you, and it is good to know you are doing much better sir. Once again, my deepest apologies for the delay in my response.

Best wishes.
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Follow-up: Suggest treatment for E. coli ESBL in urine 29 minutes later
Dear Doctor,

Many thanks for your reply and i understand your situation as well, i was actually wondering if you were on vacation and that's why the delay.

Yes i am feeling better now 3 days after the my course completion, my GP when he prescribed Nitrofurantoin last week for 5 days said, that this dosage was enough and i need not come back to him until and unless if i felt i still had the infection, It was out of my curiosity i visited and asked for a urine culture for which he said wait for atleast a week. Also i asked if the nitrofurantoin dosage was enough for 5 days and he said generally they write only for 5 days.

So since i am feeling better, i didnt have an issue with this.

Regarding the anal itching it is going down day by day, I was wrong when i said urethral itching as i was a bit confused, I don't have any urethral itching at all any were near my urethra, its ONLY inside my anus.

So if i understand you correctly ONLY if i have urethral itching, its a sign of resident infection and i go back to the doctor, but its not required if i have mild anal itching and no urinary symptoms?

The reason i ask is, i got this ANAL itching ONLY after i started using antibiotics (after 5 days of mecillinam) and i didnt have this when i got the first UTI.

 
 
Answered by Dr. Shoaib Khan 44 minutes later
Brief Answer:
Yes sir, nothing to worry about

Detailed Answer:
Hello once again sir.

A doctor is never on vacation, we are always here to help anybody you needs it sir. :)

Yes sir, you are right. Only if there were urethral itching would we have to worry about a resident infection. The anal itching will soon subside, and nothing to worry about sir. So dont worry about it, and if at all there are new developments or god forbid worsening of the itching, please write back to me and I shall guide you from there on.

Your doctor,
Dr. Khan.

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Follow-up: Suggest treatment for E. coli ESBL in urine 19 hours later
Dear Doctor,
Today i had a small burning sensation and foul smell after i passed my first urine in the morning, the foul smell was the same which i had when i had the UTI :-(.

I had a urine home dip stick test kit which i used and it immediately turned pink which shows the infection (i used http://www.nitristic.com/mainen.htm). Does this mean Nitrofurantoin treatment for 5 days was not sufficient or was the drug not effective? I am only left with very few options i assume now. Does taking the same tablet again for a longer duration work or would it develop resistance to this tablet nitrofurantoin?

Also i read previously that using carbapenems is the ONLY treatment for serious infections, does this mean that now i would have to be put on Carbapenems and isolation, i am getting many disturbing thoughts :-( as i dont want to leave my family. Also by using carbapenems is there a risk to develop resistance to carbapenems? if so what are the options?

I am feeling worried and writing to you for an expert opinion, i will have to call my doctor today to see if i can get appointment else i have to wait till monday.

Would be great if you can answer me, thanks

Just to add, got an appointment today at 1400 with my family doctor, can you tell me what to ask for in terms of tests/treatment?
I will update you once i get back from the doctor, mean while i await answers from you for my above questions, thanks
 
 
Answered by Dr. Shoaib Khan 4 hours later
Brief Answer:
All queries answered sir

Detailed Answer:
Hello once again sir.

I completely understand your anxiety sir. But please listen to what I have to say first, to understand things a little better.

First of all, an early morning urine sample can be the most concentrated sample of the day, which is why it is considered the most accurate one. If possible, please give your early morning urine sample to the laboratory for a urine analysis, if at all the infection is confirmed we shall take it forward from there.

I have treated many individuals suffering from EBSL and recurrent urinary tract infections. And from my experience, when such above mentioned individuals approach me, a long course of a sensitive antibiotic to help cure their infections permanently have proven to be extremely effective. Which is why I expressed concern earlier to the short course prescribed to you.

So in my opinion it is not a resistance you have developed to the antibiotic, or not that nitrofurantoin is ineffective in your case but because the course prescribed was ineffective. In such cases, a 10-14 day course proves to be most effective in solving the problem.

As for carbapenams, we would not even have to consider this right now mainly because you are not resistant to the less severe antibiotics and they can all be used to treat all the common infections that you may encounter in your life. Carbapenams are more commonly left for infections that come in our old age, when we are immunocompromised and when simple infections can present in a serious manner.

So, you are not resistant to nitrofurantoin and you need not go on carbapenams or be isolated. Report for a urine analysis, which will report in 15 minutes to an hour. Report to your doctor and discuss the confirmation of the infection and request for a 2 week course at the least of either nitrofurantoin itself or another susceptible antibiotic this time.

So ask for a urine analysis, and a 14 day course to be able to adequately treat an infection like yours. This is the only way. In most cases, symptoms disappear after 5-7 days on antibiotics, and doctors choose to discontinue the antibiotic thinking the infection has been eradicated, but a few days after discontinuation, the infection reappears. For this reason, I insist on a 14-day course and not the usual 5 or 7 day course, for complete eradication.

I hope I have explained things in a manner best understood by you sir. If at all there is anything unclear or if there is anything you need further clarification for, you know you can always rely on me.

Best of luck sir.
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Follow-up: Suggest treatment for E. coli ESBL in urine 20 hours later
Dear Shoaib,

The ONLY reason i come back specifically you with my questions is you are an XXXXXXX with your great knowledge and information you not just treat the patient illness but also his worries. Here is an update from my doctors visit yesterday.

The doctor ordered a new urine culture yesterday and u submitted my samples, she said by Monday i would get a report if the infection still exists. She then prescribed the same Nitrofurantoin 50mg three times a day for 7 days :-(, I aksed for an extended dosage and told her that my doctor in XXXXXXX feels i should get atleast 10-14 days course, for which she said that in Sweden they follow this duration and will extend in worst scenarious, but then she said based on Mondays report she would again see. She did not order a Urinanalysis

Do you think Urine culture is better in this case? Also should i ask for a Uro referral on monday as they can prescribe better dosage for a longer duration as the GPs here generally dont extend?

Also doctor, I used Nitrofurantoin for 5 days first then stopped the course for 4 days and then started again now for 7 days, do you think the tablet would be effective ? I have used Cefixime, Mecillinam also before this for 5 days each, Generally how long will it take to develop resistance for an antibiotic like Nitrofurantoin, cefixime, mecillinam etc for a person like me without any other major illness?

Also sir, will an urine culture detect all the different types of ESBLs causing infection? In my case the previous report said i had E.coli ESBL, but i read that there are more dangerous types like k pneumoniae esbl, can these be detected as well? or would i first see the symptoms if i had any of these? Any thing to worry here?

I feel better and trust you completely and when you said that you treated many individuals with ESBLs permanently, i felt that i was not alone and there are many people who are trying to overcome this problem.

I would like to with your permission ofcourse have you as my Physician/Specialist for all advises and referrals in the future, hope this is OK for you, i will update my status again on Monday with the report. Until then i wait for your answers, Thank you sir and have a great weekend.
 
 
Answered by Dr. Shoaib Khan 4 hours later
Brief Answer:
Everything should soon be fine

Detailed Answer:
Hello once again sir.

Thank you so much for the kind words, but I am only human and God is everywhere. He works through you and me. :)

Starting with the urine culture and sensitivity. I had only asked for a urine analysis as it would report signs of an infection in the urine within 15 minutes of providing the sample. But a urine culture would and is much more effective and helpful for us.

A urine analysis only provides vague signs of an infection, but does not tell us anything more than this. Whereas, a urine culture and sensitivity report gives us the following information:
-Whether infection is present or not
-Which micro-organism is causing the infection (eg. E. coli, ESBL, etc.)
-A list of antibiotics will be used in the laboratory against the organism causing the infection, to see whether or not the organism is killed. This infections gives us information about which antibiotic is effective (how effective also) and which is resistant.

I completely understand why your doctor would only order a 7 day course, as it is textbook knowledge not to give a longer dose, because antibiotic tampering can lead to resistance in individuals. But, if at all required (i.e. in resistant cases or cases with resilient infections) we have to extend the course until the infection is completely treated. You see, medicine does not come with hard and fast rules. It provides us with knowledge, and we at times have to use that knowledge added with some common sense to help people who come to us. If I would operate on all my patients with the same technique taught in my textbooks, at least 30 % of them would either be dead, or handicapped by now.

You could request a urologist referral, as in XXXXXXX and other countries, only a urologist should be handling such cases. I am XXXXXXX by birth, but am not located in XXXXXXX sir.

Do not worry about resistance sir, Nitrofurantoin will be as effective in you as it was the first time, only a longer course is required for it to be able to tackle the infection. It is like sending 10 troops to kill a 100, instead I am advising to send a 100 to kill a 100.

Resistance develops over a long time sir, repeated use, poor prescription by doctors, poor following of instructions by patients and not completing their courses, etc. You need not worry about this as it develops in months/years.

No sir, you need not worry about anything. The new culture should report the same infection-causing organism, as you might have understood what has happened in your case. The nitrofurantoin was successfully killing the infection, but as soon as we stopped the dose, the little infection-causing organism that was remaining could not be killed due to the lack of nitrofurantoin supply. So it multiplied and caused an outbreak again.

ESBL is not common, but when I used to practice in XXXXXXX there were a few less fortunate (financially) patients who used to report to the hospital with such types of infection.

You are most welcome, to always keep in touch. As long as God looks over us, I shall always be available to help you and your family sir.

Best wishes sir.
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Follow-up: Suggest treatment for E. coli ESBL in urine 3 days later
Dear Shoaib, Hope you are doing great ! An update on my status.

UTI symptoms all dissappeared, however

The problem started on the 4th day of taking Nitrofurantoin when i noticed shortness of breath, i kept continuing Nitrofurantoin and on day 5, i stopped taking the drug as the shortness of breath became worse. After 36 hours of stopping the drug i still have shortness of breath but not worse. My general physician now put me on Pivmecillinam now, which i would start taking from today afternoon.

As always i read from the internet and had many questions and as ever i trust you for the best answer which you always give

I have read about Acute Pulmonary toxicity on the internet due to Nitrofurantoin, Will it resolve on its own? I still have slight shortness of breath now, but most of the websites said the symptoms will resolve in 24 hours, which in my case have not completetly gone. Also since i have taken for total 8 days 50mg three times a day, did it have caused any permanent damage to my lungs? I mean does this acute lead to chronic toxicity even after Nitrofurantoin is stopped?

Second question is does the other antibiotic PIvmecillinam also cause this lung toxicity which can cause serious lung damage? I am very worried as i never had shortness of breath before except when i had some colds. Except for this shortness of breath, i dont have any symptoms, Also i will wait for the answer before i will start Pivmecillinam

Also read that in severe cases they use corticosteroids, Will my lungs re-cover completely? Would be great if you can answer my question soon, thanks
 
 
Answered by Dr. Shoaib Khan 10 hours later
Brief Answer:
Should subside soon, pls initiate pivmecillinam

Detailed Answer:
Hello once again sir.

It is good to know that your urinary symptoms have almost completely disappeared.

As for your latest questions sir,acute pulmonary toxicity is a side effect of using nitrofurantoin, but so is simple breathlessness. Either of them will subside as the drug exists your body, and should completely resolve in due time sir. It will certainly resolve on its own sir, drink plenty of water which will help with the natural expulsion of the drug from your body.

No sir, there have been no reported cases of permanent lung damage with nitrofurantoin use since it was first introduced sir, so please do not worry about chronic toxicity.

With pivmecillinam use there have been no reported cases of lung toxicity, but there is a side effect which results in tiredness which can make breathing a little more difficult than normal, but this is not due to any lung toxicity. So please do not worry sir, initiate the course of pivmecillinam and make sure you drink plenty of water. Nothing else would be required sir.

Yes sir, in severe cases corticosteroids are used but I do not think that will be required sir. Let us give this some time, and watch for a few days how the breathlessness goes.

I hope and pray for your quick and complete recovery sir. Had a long day at work and thus the delay in response sir.

Best wishes.
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Follow-up: Suggest treatment for E. coli ESBL in urine 10 hours later
Dear doctor,

Thanks for the answers, And i can completely understand for a doctor like you to be busy all the time. The reason i write also is when you explain i feel more confident. Today morning woke up fresh and i can feel a little better on the shortness of breath.

My GP called me yesterday to check everything, She did a physical examination and a chest x-ray (just to clear of my worries), i also asked if i can get tested for Pencillin allergies which she ordered, i gave all my samples and in the evening she called me with the X-ray and blood test results, she said x-ray and blood reports came back normal and nothing to worry for, My lung capacity was 98% which she said is good, also the X-rays didn't show anything suspicious. If i had any inflammation in the lungs or issues because of Nitrofurantoin, i think it would have shown in the X-ray right? Also if everything was fine, is it a hypersensitivity towards Nitrofurantoin which is causing my shortness of breath?

Allergy tests for Pencillin will come may be tomorrow, but meanwhile yesterday i started Mecillinam 200mg three times a day, i didnt have any allergic reactions yet and i hope i am not allergic to mecillinam as i took it 3 weeks back first when my symptoms started. The doctor told me if i was allergic to pencillin, i wouldnt be sitting here as it would be an emergency and the symptoms appear within 1 hour of taking Pencillin, so i can take Mecillinam without any issues, i guess

Also if the test says i am not allergic to pencillins then i guess i wont be allergic to other classes of antibiotics like cephalosporins, carbapenems right?

Also as you said i am drinking alot of water, started doing some yoga breathing exercises for 30 minutes every day, Sweden is very beautiful in summer so am taking some walks as well. I just want to get rid of this ESBL and all antibiotics.

Also Shoaib, now i have been on antibiotics for more than 3 weeks, do you think this causes any issues? I just want to stop them as soon as possible.

Also which country do you live? Are you working in europe? Have a great day and hope to get your comments when you get time
 
 
Answered by Dr. Shoaib Khan 5 hours later
Brief Answer:
My pleasure to address all your queries sir

Detailed Answer:
Hello sir.

I am humbled by the confidence you have in me sir, I shall always strive and work harder and harder in order never to let you down.

Yes sir, you are quite right. Any abnormality, even mild inflammation can be seen on a chest x ray. And as I had informed you earlier sir, nitrfurantoin does not always cause acute pulmonary toxicity, at times it can just cause simple breathlessness, may be we could consider this to be your side effect and not lung toxicity. If at all, the side effect experienced by you was just simple breathlessness and as a result of the nitrofurantoin use, then we wouldn't be able to see any chest x ray changes, and this breathlessness will/should subside as and when the drug starts exiting the blood stream (which is also what you have been experiencing).

Your doctor is right, at times even an hour is not required; I have seen a young male who reacted to a test dose within 4 minutes of its administration. So I am more than positive that you are not allergic to penicillin's sir, so do not worry about this.

No sir, an allergy is normally restricted to one class of antibiotics; so it actually depends on the test conducted. If your blood was tested only against penicillin's and it reported no allergic reactions, then you are not allergic to only penicillin's. But if the drug allergy test was more elaborate and it tested you for all groups and classes of drugs (which is less often done, as there are too many drugs and drug classes to conduct an elaborate evaluation), only then can we assume that you are not allergic to all other classes like cephalosporins, etc.

Yes, please continue with the consumption of plenty of water and good breathing exercises. Heavy breathing for a few hours can result in the loss of almost a litre or more of water from the body; so this is also a good way to help with expulsion of the drug from the body. Please stay hydrated. I am sure Sweden is amazingly beautiful, I wish to visit with my wife some day. Although visa issues are quite a limitation.

I do not think this should cause any issues as you have been on different antibiotics during this duration of time. I hope and pray all is resolved soon, and no resistances are developed. All we can do right now is concentrate on getting you healthy as soon as possible, and worry about the rest later. So let us take one step at a time sir.

I currently live in Russia in a city called Kursk sir, and yes I am working here, although Russia is considered EurAsia, more than being considered to be Europe.

I wish you a great day ahead too sir.

My best wishes to you and your family.
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Follow-up: Suggest treatment for E. coli ESBL in urine 6 hours later
Dear Shoaib,
Many thanks for the response and thanks for clearly writing in detail, May be my anxiety is making my breathlessness worse, i guess.

However is it possible to still have shortness of breath like a mild reaction with the use of Pivmecillinam 200mg three times a day? I am using it for more than 24 hours (from yesterday morning 11) and have taken 5 tablets till now. Strange thing is today morning i was feeling well, but after lunch my shortness of breath came back and is a bit worse now. But i dont have any other reactions like rash or swollen glands or wheezing like symptoms.

Can you become hypersensitive like this on day 2 after more than 24 hours? or is it my anxiety thats causing shortness of breath? I am still waiting for my Penicillin allergy test reports, may be tomorrow i can get them as i gave my blood samples yesterday. Should i still continue?

Nice to know that you are in russia, i've added you in google circles and let me know if you wanted to visit sweden, i can arrange the invitations for your visit and take you guys around. Hope to hear from you soon
 
 
Answered by Dr. Shoaib Khan 19 minutes later
Brief Answer:
I feel anxiety is your only problem sir

Detailed Answer:
Hi sir.

I doubt you can develop an adverse reaction after more than 24 hours of use, as if you were sensitive to it you should have reacted to it immediately after the first contact.

Pivmecillinam does not really have side effects of breathlessness sir, and so I think this is either due to anxiety or a possible panic attack due to the infection and all the other trauma and discomfort you have been experiencing recently. So do not worry, and please continue the medication as it is what seems to be helping to eradicate your infection as of now sir.

As for a visit to Sweden, I would love to visit there with my wife. But would not want you to go through the trouble of making all the arrangement. If possible please do recommend the best way to arrange for the visa. Once the visa is arranged, I would love to come visit Sweden and also spend some time with you. My wife has been waiting to visit Sweden for quite some time. I shall accept your invitation on Google circles as well for further communication on this matter.

Sir, I feel you are just getting too concerned about the infection and possibly the medications not suiting your system or not being effective enough to help you. This happens in many individuals who have been suffering from a long lasting or resistant infection. Have faith in the medications, and believe that you will soon recover. This is pivotal and will surely help in bringing you closer to good health and sooner.

For everything else, I am always here to help so please leave all the worrying to me, and get all the rest you can while taking your medications religiously.

Keep in touch and best of luck sir.
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Follow-up: Suggest treatment for E. coli ESBL in urine 16 hours later
Dear Shoaib,

No problem, i can send you the details of the VISA and how to arrange them. Also i can give an invitation letter for your visit, dont hesitate to ask me, I will send it to your google+ account.

I got my Pencillin allergy test report today, the doctor said that allergy test was negetive, however she could see a value 0,13 in the blood report which suggests some sensitivity towards Penicillin, She said in order to declare allergic the value should be 5, however i have 0,13, She thinks i might have a pollen allergy which is causing my shortness of breath and not the Pivmecillinam, what do you suggest? Will this hypersensitivity develop into allergic reaction in the future?

Also does this mean that now i would be sensitive to other antibiotics like cephalosporins, carabepenems ? What is the difference between Allergy and sensitivity, Will it go on its own and i can still take these antibiotics now and in the future or do i need to exercise any caution?

Would be great if you can answer my questions. Thanks Also if you could explain me, i didnt understand when the doctor said sensitive to penicillin and not allergic because of the value 0,13, One thing i understand is being sensitive to penicillin might cause mild symptoms and not shortness of breath (She was very confident that penicillin senisitivity wont cause shortness of breath and its due to Pollen allergy).

Does a normal person has the same range of value or should it be 0?
 
 
Answered by Dr. Shoaib Khan 2 hours later
Brief Answer:
I also believe this is because of pollen, dust,etc

Detailed Answer:
Hello once again XXXXXXX

Let me first explain what your doctor meant by sensitivity and resistance. An individual can either be sensitive/susceptible or resistant to a particular antibiotic. If they are sensitive to it, then it can be effectively used to treat infections in them, and if it is resistant then that particular antibiotic cannot be used to treat any infection in the particular individual.

So if at all your doctor was talking about what I think she was, then she meant to say that penicillin's can be used to treat you, and you are not allergic to them, but your body seems to be reacting to some substance due to a value of 0.13. This is a minor allergic reaction which in most cases is registered due to hypersensitivity reactions from dust, pollen, etc. For this reason your doctor is suspecting a pollen or dust allergy and not a drug allergy.

Your doctor is quite right when she said that the value has to be above 5.0 for us to suspect a drug allergy. So it could quite be possible that the pollen, that is prominent in this season could be causing your breathlessness. So in conclusion, I agree with her. And this will remain to be a hypersensitivity reaction sir, you will just have to be careful during this particular season and also keep anti-histamines accessible during this time.

As I explained in my last response sir, drug allergy tests are usually for a particular drug group (eg. penicillins, carbapenams, etc.). So if you have been found to be allergic to penicillins, that does not mean you are allergic to cephalosporins, carbapenams, and other groups as well, but only penicillins.

An allergic reaction is when your body cannot tolerate the substance/allergen at all and can result in severe reactions, whereas a sensitivity is more simple, with more simple symptoms.

The thing about allergies and sensitivities is that they appear and resolve without any indications. As a child, I used to eat a lot of sunflower seeds. After relocating to 3 different countries and now Russia, I tried chewing on some sunflower seeds and developed a severe allergic reaction to them. So you see, I was once comfortable with them, and now my body cannot tolerate them. Allergies and sensitivities can come and go sir, not always, but they cannot be predicted. The only caution you need to exercise is for the pollen, and nothing else as of now sir.

Yes sir, your doctor is right. You can tolerate penicillins and the value seen on the test is most probably due to pollen, dust, etc. So do not worry about that, I assure you.

A normal person can have a value of 0-0.2 and so on, without having any serious reactions, but a value of 0 is seen more often. So you are also completely normal my friend.

As for the visa, please do let me know how I can go about the process of application. And if at all I need to invitation from you, I shall surely let you know. Thank you so much for that.

I hope you find my response helpful XXXXXXX By now you should know that I do not need to inform you that you can write to me anytime. I am always available to help you.

Best wishes.
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Follow-up: Suggest treatment for E. coli ESBL in urine 12 days later
Dear Shoaib,

Hope you are doing great and in good spirits, After a week of 5 days of finishing the 1 week antibiotic therapy with Selexid, i gave my urine sample for culture and got the report yesterday.

The culture was negetive :-) i am very happy that atlast the bacteria esbl left my body, the doctor said that now i dont have the bacteria any more which was a big relief, The report cleared me of all worries and issues, I also dont have the foul smell or anything which i used to get before once i stopped the antibiotics.

I have to thank you for all the help and support you have been giving me to recover, Also your knowledge about these infections is commendable.

I have few questions which i wanted to clear, as always i know you would provide me with the best answer. Since now, i have got rid of the infection completely, is there a chance that the bacteria might come back, i mean i heard that this bacteria resides in the gut, can it come back? My doctor said that she also treated another person who had the same infection, but he still had the bacteria but no infection, i didnt understand this, whats the difference between him and me as i have cleared the infection?.

Secondly sometimes i have a slight itch in the urethra, its very mild and comes sometimes only after urinating in the morning, but i should say its very mild, I have been eating alot of Fruits and fresh vegetables lately like fresh garlic salads etc, the doc said since there is no infection it could be if your urine is too acidic etc.

Thirdly what precautions i have to take in order to protect myself and my family from such type of infections? I have started a healthy diet and cutting down on sugars to boost the immune system, Would appreciate if you can provide me with some tips, for example if i go to a hospital would i be at risk of contracting the infection again, if i am cleaning my hands would that be enough?

Would appreciate if you can answer me, I am very happy now
 
 
Answered by Dr. Shoaib Khan 1 hour later
Brief Answer:
Great news sir!!!

Detailed Answer:
Hello once again sir.

That is great news indeed, I am more than happy that you have finally rid yourself of the infection.

What your doctor means is that this bacteria is found and seen in the gut, and it can reside there without causing any harm to the individual or causing any infections. Similarly, for the individual your doctor was talking about, the bacteria continues to reside in his gut but will not cause any trouble unless it comes in contact with any other internal organ other than the gut. The gut is resistant to this bacteria, but other parts of the body are not. Which is why you have to practice extra care and take extra precautions when you wash yourself after a bowel movement. Make sure you do not make contact with your genitalia while washing your anal region. The bacteria will be present with the feces and if it comes in contact with your genitalia it can result in an infection.

Make sure you clean your hands well enough after cleaning yourself, this is also of utmost importance. Also wear clean inner wear, in order not to cause stagnation of the bacteria in your inner wear, and it reaching the urethral opening.

As for your question about it coming back, as I had mentioned sometime much earlier in our discussion sir, the infection needs to be adequately treated. Most individuals and some inexperienced doctors choose to discontinue antibiotics as soon as the individual is symptom-free. This is not correct, as the absence of symptoms does not always indicate the absence of an infection. You are both symptom-free and also have tested negative for the infection, so chances of a recurrence is absent unless you do not take good care in regards to your hygiene (as I have explained above).

Yes, your doctor could be right. As the culture has reported no infection, there is absolutely nothing to worry about. Start drinking plenty of fluids on a regular basis, more during the day time and a little lesser during the evening and night. This should help solve your problem.

The main approach is self hygiene sir. Make sure you wash your hands frequently, especially when you come in contact with objects that are public. Carry a hand sanitizer around at all times (like in your office drawer, in your car, etc.). Keeping your hands and genitalia clean is more than enough sir, you should be able to protect yourself and your family from infections.

I hope you find my response helpful sir. I am also extremely happy to hear about your recovery. If you need any help in the future (I hope you are always healthy and do not require my assistance), but if you do, you know I am only a click away. Here is my direct link, if you wish to write to me directly from now on:

http://doctor.healthcaremagic.com/doctors/dr-shoaib-khan/64581

Best of luck sir.
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Follow-up: Suggest treatment for E. coli ESBL in urine 36 minutes later
Thanks alot for the great explanation, I am keeping alcohol based hand sanitizes at home, in my car etc, but now i will also keep one on my desk at work. I am taking extra care now at home after bowel movements, i am cleaning the toilet seat as well with a Hygienic wet wipe so that no bacteria resides there.

Also Shoaib, what parts are male genetalia ? you mentioned about feces coming in contact with genetilia, is it the urethra opening you are talking about or the whole area? Does it also cause an infection if the feces touch the normal skin under ? I use toilet paper and some times it touches the skin and not the urethra and also later i wash it with soap, hope this approach helps, Also i am drinking alot of water during the day and flushing out the toxins.

I would definetely contact you if i had any more questions in the future, Also how is it going with your travel plans to visit Sweden?Also shoaib, forgot to ask, does it still mean that there could be esbl present in my gut still, even if there is no infection and no symptoms, How long does it take and how to get rid of this esbl from the gut?


Basically i thought you would get infected if a person with unwashed hands after his bowel movement touches your hands and you some how ingest this in your body through mouth or through urethral opening, Is this still the main ways of getting the infection into your body i mean mouth and urethra?
 
 
Answered by Dr. Shoaib Khan 59 minutes later
Brief Answer:
Urethral opening is the most sensitive region

Detailed Answer:
Hello XXXXXXX

It is my pleasure entirely to be of assistance.

I am mainly talking about the urethral opening (the opening on the penis through which urine is passed to the external environment). This is the part you need to be careful about, as the bacteria can enter from here and cause an infection like the one you had XXXXXXX

No it should not be a problem if the feces touches the skin under, as long as you clean the region after this. Continue using liquid soap or solid soap in the region after passing your bowels, then dry it off with toilet paper.

Drinking plenty of water is important not only now to promote recovery, but also for the rest of your life my friend.This approach should really help.

As of now, the plan to visit Sweden is facing a few obstacles as the requirements for the visa application are all a little too complicated (like the medical insurance, and so on, etc.) So as of now, although we really were looking forward to visiting to Sweden, the requirements are quite a long list which are not all easy to get.

Yes, it could be possible that ESBL is present in your gut. And it does sometimes remain there, but it can sometimes completely get eradicated. So it is hard to say whether or not it will go completely, and when. It is for this reason that I have asked you to take the necessary hygiene precautions XXXXXXX So do not worry about it, continue being safe and hygienic and all shall go well.

Yes either this way, or if an individual has ESBL in his/her gut and some how due to improper hygiene the bacteria reaches from the gut to the urethra. I hope this makes things a little more clear my friend. As I have always said and do not need to repeat, please do not hesitate to write to me about anything, I am always here to help you.

Best wishes.
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Follow-up: Suggest treatment for E. coli ESBL in urine 4 minutes later
Well nice speaking to you and let me know if i can come for any assistance for your sweden trip, we will stay in touch with google plus and feel free to contact me.

I will take you guys around when you visit here and would be my pleasure to have a friend like you. Take care and best regards, hope to see you soon
 
 
Answered by Dr. Shoaib Khan 2 minutes later
Brief Answer:
See you soon, God willing

Detailed Answer:
Hoping for the same my friend. We shall let you know as soon as things are sorted.

We would love to visit you and your family as well.

Best wishes XXXXXXX
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