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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for fever while on antibiotic treatment for UTI

Answered by
Dr. Ravi Bansal


Practicing since :1996

Answered : 353 Questions

Posted on Sat, 3 Sep 2016 in Kidney Conditions
Question: XXXX:
Dear Dr. Nephrologist,
My girlfriend has had complaints of her belly (right kidney) and blatter regions since last sunday.
Medicinal background
Irregular thyroid (too high and too low levels) Hashimoto?
No known allergies to medicin or…

Monday and Tuesday this week she went for examination and the doctors have diagnosed her with pyelonefritis, kidney infection. After an echo, blood and urine cultures. (Echo to rule out appendicitis).

The initial blood and urine reports I have added as attachment. Currently she has been given antibiotics since 12:00(pm) Tuesday. Now it is 00:00(am) friday. 60 hours have past.

The antibiotics given are co-trimoxazol (400mg sulfamethoxazol and 80mg trimethoprim per pill). every 12 hours 2 tablets.

Besides this she takes 2x 500mg paracetemol every 6 hours. (4000mg a day)

Her fever is mostly 37.5 degrees or less. The fever goes up til 38.5-39 at the end of the paracetemol cycle (after 5.5-6 hours).

She had an upset stomach and resulting some diarrhea. Because of initial upset stomach we have asked for just in case a replacement medicin.
The replacement medicin is Ciprofloxacine Actavis 750mg.

We have not yet taken the replacement medicin yet. As her condition is improving (mental clarity, appetite, activeness, less pains in belly). All though I did not like the fever spike today. And I would have liked to see it be lower.

Tomorrow (after 72 hours) I want to make another try to postpone the paracetemol and see how the fever responds. I am afraid we have to switch.
My questions:
1. Should we in your opinion switch the medication if the fever is still too high tomorrow? (72 hours after co-trimoxazol)
2. Is the paracetemol something we should continue as long as the fever lasts? Or try to take less?

thank you
Answered by Dr. Ravi Bansal 7 hours later
Brief Answer:
you can change antibiotic if fever persists

Detailed Answer:


It seems your friend has urinary tract infection and she is on antibiotics for same.

If the fever is persisting even after three days then antibiotics should be changed generally according to antibiotic sensitivity in the urine culture.

paracitamol is an antipyratic it does not have much side effects and should be taken if fever is discomforting. Yes you can try to delay use of paracitamol so that you know that whether the fever has gone or not. antibiotic change should be done under guidance of your doctor. there are lot of agents to choose from ciprofloxacin is a good agent. cefexime is also a good alternative.

meanwhile , she should also drink a lot of water 3Litre /day. and avoid sexual contact as that can perpetuate the infection.

In rare cases if the infection does not settle you may need to give injectable medications.

best wishes.
Above answer was peer-reviewed by : Dr. Priyanka G Raj
Follow up: Dr. Ravi Bansal 3 hours later
the results from hospital say bacteria is E.coli would the cotrimoxazol be the right one?
Answered by Dr. Ravi Bansal 1 hour later
Brief Answer:
senstivity is more important

Detailed Answer:


the urine culture reports are of two parts. one is bacteria identification which you have told is E-coli. the other part of the report is sensitivity report. this tells us which all medicines are good to treat the isolated ( identified) bacteria in your case.

I personally feel you should change the antibiotics if fever is not resolving. highlight to your doctor that you are still having tummy pain and high fever.

best wishes.
Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar
Follow up: Dr. Ravi Bansal 1 hour later
Hi Dr. XXXXXXX Bansal. The sensitivity report said that the first medicin, the cotrimoxazol should work
Answered by Dr. Ravi Bansal 6 hours later
Brief Answer:
then that is a correct medicine

Detailed Answer:


If that is sensitive medicine then we should see response in next 24 hours- if fever persists then we should change

best wishes
Above answer was peer-reviewed by : Dr. Raju A.T

The User accepted the expert's answer

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