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Will It Be Ok To Reduce The Dosage Of Nitrofurantoin?

Posted on Sat, 23 Aug 2014

Question: Hello Dr.Sasanka,

Hope you are doing well.

Just to update you on the status, things are good so far with Vesigard 15mg and controlled fluid intake . There is little or no incontinence. However, recently we had to travel (via train) and decided to use indwelling catheter as using CIC seemed risky. After switching back to CIC after around 24 hours the incontinence remained for around 2-3 days. I've few questions :

It's been around 5 months she is on medication, but once we stop medication the incontinence comes back.
Shouldn't the medication helping in long term to improve the bladder capacity & incontinence? Also, does we have to rely on the medication life long ? What if the medication does not work after say 2 years, do we have a plan ?

Secondly, she is on Nitrofurantoin 100 mg for five months too. Do we need to continue the antibiotic ? Should we gradually reduce the dosage (i.e. alternate days only) or get off it completely.

Serum creatine levels are normal and there is no symptoms of infections so far. Things are good now but I'm worried about the future and need to prepared. Please suggest.

Thanks for you help so far. We are also planning to consult a neurologist/neurosurgeon. We need to get the back bone checked to ensure the everything (screws/rods) are in place. Could you please recommend a neurologist/neurosurgeon who can be trusted for advice?

Answered by Dr. V. Sasanka (49 minutes later)

Brief Answer:
vesigard to be continued

Detailed Answer:
Hi,

Glad to know your wife is doing well. I suggest she continue Vesigard at the present dosage. There is no harm. It is meant for this. The alternative is Botox injections which will give benefit for 8-9 months and later you are back to drugs.

You can reduce the Nitrofurantoin to 50mg once a day and see if she continues to be comfortable.
You are welcome to meet the neurosurgery team in our hospital. They are nice.

Regards.

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. V. Sasanka (30 hours later)

Thanks Dr.Sasanka,

We'll reduce the Nitrofurantoin dosage to 50mg. Just curious if long term antibiotic dosage is necessary (and safe)at the current stage (No catheter, only CIC) ?

Thanks.

Answered by Dr. V. Sasanka (1 hour later)

Brief Answer:
May stop and see if problems recur

Detailed Answer:
Hi,
The dose your wife will be receiving is 50 mg of Nitrofurantoin which is a minor dose, and usually should not encourage resistance among bacteria, with minimal side-effects, and also has the ability to keep febrile urinary infections under check. If your wife does self-catheterization exactly as she should, there might not be need for this small dose, and if you are not comfortable with taking an anti-bacterial on a long term basis, you can try stopping the drug and seeing if there is a recurrence of infection like she was experiencing earlier.
You are welcome to do this - and please inform me if she has any trouble. I suggest she continue the medication to reduce urinary urgency. She should not reduce the dose or miss it. That can be disastrous.
Regards, and best wishes.

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