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UTI, taken Faropenem, done urine culture, history of interstitial lung disease, bacteria in culture. Aztreonam advisable?

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XXXXXXX XXXXXXX F/70, Case of recurrent UTI. (Post void is normal)

Prexisting Interstitial Lung Disease with 24x7 Oxygen.

Latest Bacteria: E.Coli ESBL found in Urine Culture

Bacteria is sensitive to: AMIKACIN 24mm (but since this has been given earlier, not advised by UROLOGIST), AZTREONAM 23 mm, COTRIMOXAZOLE 24mm, IMIPENEM 23mm, MEROPENEM 23mm

She is being administered Faropenem Sodium ER 300mg BD since yesterday night.

Urologist has also advised AZOM (Azteronam Injection) 500mg TDS since ..but not administerd as the leaftet of drug manufacturer states:

DOSAGE and ADMINISTRATION: Certain antibiotic (eg. Cefoxitin, imipenem) may induce high levels of beta - lactamase in vitro in some gram-negative
aerobes such as Enterobacter and pseudonomas species, resulting in antagonism to many beta-lactam antibiotics including AZTREONAM. These in vitro findings suggest that such betalactamase inducing antibiotics not be used concurrently with aztreonam.

Case history:

Interstital Lung Disease Patient with

Recurrent UTI with significant post void (110ml) ...later Sonography showed insignificant post void

History of Bacteria found List (in culture) : E.Coli, Pseudonomas Aeruginosa, now E.Coli ESBL

UTI found on XXXXXXX 26, 2011, admitted in Hospital.

Antibiotics administered: (History wise)

IV: Magnex, Loxof, Fixra, Amikacin

Oral: Loxof 500, cefuroxime axetil, prulifloxacin

ADVISE REQUIRED for concurrent therapy of Azteronam Inj. Concurrent Therapy with faropenem Oral. Can we give the Azteronam / else what is to be done?
Posted Fri, 27 Apr 2012 in Urinary and Bladder Problems
Answered by Dr. Dilip M Babu 18 hours later
Thanks for the query.

I have gone through your case history.

Your patient is having recurrent UTI - urine culture suggestive of E.Coli [ESBL].

Only current approved therapy for ESBL E.Coli is the carbapenam family i.e. Imipenam,Meropenam and ertapenam.

Aztreonam will not help.

My advice to this patient is she should recieve either meropenam or ertapenam.Ertapenam will be preferred as it is single dose daily.

Note that ertapenam will not cover Pseudomonas.I think this patient should undergo urodynamic study for significant post void residue after treating urinary tract infection..

Hope i have answered your query.I will be available for follow up.

Above answer was peer-reviewed by
Follow-up: UTI, taken Faropenem, done urine culture, history of interstitial lung disease, bacteria in culture. Aztreonam advisable? 1 hour later
You have advised ertapenam. However she is taking Faropenem Sodium ER 300mg BD since 6/9/2011 evening. It has been advised by UROLOGIST to be taken for 6 days. Should we continue the Faropenem Sodium ER 300 mg BD and start ertapenam also, please advise ?

What is the name of exact ertapenam medicine (and mg) to be started and for upto how long it should be taken?

Urodynamic study cannot be undertaken as the patient is on 24x7 oxygen and is mostly bedridden. However we can and have got a Sonography done, which showed the pre void as 50cc and post void as NIL;
Answered by Dr. Dilip M Babu 1 hour later
Thanks for the follow up.

There is no valid data available about efficacy of Faropenem in treatment of ESBL( Extended-spectrum beta-lactamase )ESBL E.coli.

Better to stop it after discussing with your treating physician and start ertapenam [ BRAND NAMES-INVANZ OR ZIVATOR] 1 GM to be mixed in 100 cc Normal Saline and infused over 30 min once daily for 10 days under supervision of your primary physician.

Repeat urine culture after 10 days.

We can give Faropenem 300 mg at night time once daily once UTI treated [after completing course of Ertapenam] as prophylactic drug to prevent recurrent UTI(urinary tact infection) [FOR 2 MORE WEEKS].

Wishing you good health.

Above answer was peer-reviewed by
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