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Suggest Treatment For UTI While On Bactrium

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Posted on Thu, 16 Nov 2017
Question: Hello,
I believe I have early UTI (intense urge, bad odor w/urination, small drops w/urination, and having to go frequently. My doctor is on vacation so I'm about to head to an urgent care. I'm concerned because I have problems taking many medications. I am about to head to urgent care for prescription however I wanted some info before talking to the NP. In the past I've been successfully treated for UTI (4 & 6 years ago) with 250 mg Cipro for 3 days. I'm told it's no longer recommended for UTI's but it worked well. My pharmacist told me the NP will probably order macrobid however it only comes in capsule that can't be opened (I cannot swallow pills so need to open or crush). He also suggested Bactrim which I've taken but had adverse reaction. I get strong panic attacks if taking a NEW mediations, so under these circumstances, can I ask the NP to prescribe 250 mg Cipro (no adverse affects taking in the past).
doctor
Answered by Dr. Bonnie Berger-Durnbaugh (56 minutes later)
Brief Answer:
Information

Detailed Answer:
Hello and welcome,

I can very much understand your anxiety over this. The problem with Cipro, other than that it should be reserved for severe infections because it's overuse can lead to resistant microorganisms is the it has a "black box warning". It can cause some very severe problems such as achilles tendon rupture.

Whether the NP would be willing to prescribe it again for you will be based on the individual, I think. She might be willing.

Macrobid can be taken as nitrofurantoin suspension to get around the problem of pill swallowing if that is something you would like to consider.

Whenever someone has UTI symptoms, I strongly advise they request their doctor to make sure to order a urinalysis (sent to the lab, not just a "dip stick" kind) and a culture and sensitivity. This takes a couple of days for the information to get back but is important because it will show what the microorganism is and more importantly, which antibiotics will work.

If you get frequent UTIs, and are postmenopausal, sometimes a small amount of estrogen cream applied topically can help prevent them. After menopause women lose some of the strength of the genitourinary tissues due to diminished estrogen. Topical estrogen is safer than oral, which goes through your whole body in a larger quantity.

Also, if you are sexually active, get up as soon as possible after intercourse and urinate to get out bacteria that may have been driven in. Also wash off the semen which can be an irritant.

I hope this information helps.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Bonnie Berger-Durnbaugh (1 hour later)
I'm told some suspension meds are easier to take than others. For instance, five months ago I took amoxycillin suspension for a tooth abcess. It was great tasting and zero side effects. I'm VERY disappointed that my pharmacist never mentioned this suspension as I specifically spoke to him about the problem of the macrobid capsule, and then we jumped to Cipro as an option. At this point the NP has ordered the Cipro but I'd have much preferred to take a "lower" anti-biotic first especially for this simple UTI.

Next question - I didn't obtain strong confidence in the NP prescribing. My former doctor gave me 500 mg CIPRO for 3 days. But allowed me to do 250 mg / 3 days to see if that worked. It did with two UTI's over 2 years. This NP said that the 250 dose is low so I should take it for 5 days even after I explained that I've done the three day successfully twice. She said it's better to take it the extra two days.
Do you agree? Also, should I ask my family physician to take a culture on Monday (even with the antibiotic started on Friday)? Thank you SO much for the info on the suspension macrobid.....!!!!!!! Best $15 I've spent in some time. You've been wonderful...AND I will speak to my GYN. I have been having urinary retention and she mentioned I need to make sure I really empty my bladder so I don't get UTI's. It's been 4 years since my last UTI so I think I'm doing a good job, however, I do get a burning sensation which feels like a UTI 3-5 times a month. It gets relieved with a injection of a vaginal lubricant. Would a vaginal estrogen help with this, as I feel that the urinary "urge" and retention are getting a "wee" bit worse although still manageable.
doctor
Answered by Dr. Bonnie Berger-Durnbaugh (1 hour later)
Brief Answer:
Information

Detailed Answer:
Hello -

If you already started the Cipro, it won't help to get a culture unless the Cipro isn't working.

If I have a high suspicion for a person having a bacterial UTI, I ask for a urine specimen in the office, do an initial "dip stick" test and if the stick changes color for leukocyte esterase, this can indicate that there is a bacterial infection. I then start patients on an antibiotic (typically Bactrim DS unless they are allergic to it) or nitrofurantoin (Macrobid). And I send the urine to the lab for a urinalysis and culture and sensitivity testing. Sometimes it turns out not to be a bacterial infection (there can be other causes of dysuria such as urinary stones or gravel (very small stones), postmenopausal irritation from lack of estrogen, mechanical irritation such as from sitting on a horse or bike seat, tight jeans, or from intercourse. The results take a couple of days and then I have a better idea of what to do if the antibiotic isn't helping.

If the UTI symptoms get relieved with vaginal lubricant, it is possible that the burning is from low estrogen in the genitourinary tissues. This is something your OB is likely to be able to see visually when looking at the tissues. The vagina looses some of it's folds and becomes paler in appearance. We normally don't do anything about it unless there are symptoms, such as vaginal or urethral irritation, excessive dryness and irritation during sex, or frequent UTIs (which it sounds like has not been an issue for you).

Regarding the dosing of the Cipro - if 3 days at a low dose has worked for you in the past and you don't then have a recurrence within a few days, it is likely to have taken care of the problem adequately. We want to use the lowest dose and the shortest course that eliminates the problem and doesn't result in persistent or recurrent infection.

I am sure you already know to drink plenty of water with UTI symptoms, and while the data is mixed on cranberry, I recommend that too.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Bonnie Berger-Durnbaugh (56 minutes later)
Unfortunately it was Friday afternoon when the symptoms became most apparent and my doctors office was closed for the afternoon and weekend. I did a "home test" when I woke up and it did reveal both leukocytes and nitrate. As I mentioned, I sadly can't take the macrobid capsules and am being told by my pharmacist that the suspension is pretty nasty tasting and often causes nausea/vomiting just because of the "taste". I had an adverse reaction to bactrim in 2009 so again cannot take that.
Yes, my husband is picking up the Cipro on his way home. I'm lucky that I'm not having terrible pain yet so I can wait another hour until he arrives.

Yes, twice in the past, I've taken 250mg of Cipro for three days and have no re occurrence so although the NP has suggested 5 days I feel comfortable taking it for 3 days. I'm told that CIPRO stays in your system for another 5-7 days anyway after you stop taking the medication so I'm actually getting 10 days if I take it for three days, correct?

I will talk to my Gynecologist as I've had similar symptoms to this in the past which FEEL like a UTI but feel somewhat better with vaginal lubrication and ask for a course of your suggested Estrogen.

I do find that drinking cranberry juice always makes the burning feel less intense while waiting for the antibiotic to start working. I've read the data is inconclusive, but I always jump on it the minute I feel a UTI coming on.

Thank you again for your help.
doctor
Answered by Dr. Bonnie Berger-Durnbaugh (15 minutes later)
Brief Answer:
Thoughts on this

Detailed Answer:
My personal opinion based on anecdotal evidence is that the cranberry does help.

Only ask for the estrogen cream if your doctor thinks that you look a bit deficient or agrees that your symptoms may be from a deficiency of it.

Cipro stays in the system for about 22 hours, and it's half life is only 4-6 hrs, meaning half of it is out of your body after that period of time. So no, I have never heard or read that Cipro continues to work in your body for an additional 5-7 days. You might be thinking of azithromycin which takes 15 days to be eliminated, and has a half life of 3 days. The short dose of that antibiotic works for 10 days. But azithromycin is not for UTIs. It is for pneumonia and other severe respiratory infections and certain gastrointestinal infections that may be contracted when traveling in other countries.

I think it would be reasonable for you to take the Cipro for 3 days. One protocol used Cipro 100 mg twice a day and that worked.




Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Bonnie Berger-Durnbaugh

General & Family Physician

Practicing since :1991

Answered : 3134 Questions

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Suggest Treatment For UTI While On Bactrium

Brief Answer: Information Detailed Answer: Hello and welcome, I can very much understand your anxiety over this. The problem with Cipro, other than that it should be reserved for severe infections because it's overuse can lead to resistant microorganisms is the it has a "black box warning". It can cause some very severe problems such as achilles tendon rupture. Whether the NP would be willing to prescribe it again for you will be based on the individual, I think. She might be willing. Macrobid can be taken as nitrofurantoin suspension to get around the problem of pill swallowing if that is something you would like to consider. Whenever someone has UTI symptoms, I strongly advise they request their doctor to make sure to order a urinalysis (sent to the lab, not just a "dip stick" kind) and a culture and sensitivity. This takes a couple of days for the information to get back but is important because it will show what the microorganism is and more importantly, which antibiotics will work. If you get frequent UTIs, and are postmenopausal, sometimes a small amount of estrogen cream applied topically can help prevent them. After menopause women lose some of the strength of the genitourinary tissues due to diminished estrogen. Topical estrogen is safer than oral, which goes through your whole body in a larger quantity. Also, if you are sexually active, get up as soon as possible after intercourse and urinate to get out bacteria that may have been driven in. Also wash off the semen which can be an irritant. I hope this information helps.