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Neurogenic bladder, had spinal cord injury, pseudomonas aeruginosa, muscle pain and headaches. Taken paracetamol and colistin. Normal?

The patient has a neurogenic bladder due to a spinal cord injury (5 years back), she s on indwelling catheter since. A month back The patient was diagnosed with pseudomonas aeruginosa infection after heavy fever and was admitted for 5 days. She was treated with Magnex Forte and paracetamol. At the time of discharge the fever and infection went away and Magnex forte 3g (twice daily) was recommended for 14 days. After 14 days, urine culture was repeated again and multi drug resistant klebsiella pneumoniae infection is identified. The bacteria was only sensitive to colistin and tigecycline. However, the patient is asymptomatic(no fever,chills). The doctor recommended colistin (3 million iu twice daily) with Magenx forte (3g twice daily). After first day of dosage, the patient felt weakness with mild headache and difficulty to move due to muscle pain. When asked, the doctor said this is unusual and instructed to stop the medication. Is the symptoms of weakness normal looking at the dosage? Is there any recommended medication for the weakness ? Is is ok to stop the medication prematurely ? If we stop the medication what s the next step to eliminate the infection ?
Asked On : Tue, 15 Oct 2013
Answers:  1 Views:  44
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Urologist 's  Response
The best way to eliminate infection would be to avoid a chronic indwelling catheter. If the patient cannot void urine normally, you should consult someone who can teach her to catheterize her bladder on her own intermittently. This is a fairly standard well recognized procedure throughout the world and though it may sound difficult initially, but with practice, there is no reason why she will not be as comfortable as the next person.
I would prefer to avoid antibiotics in the absence of significant symptoms, especially fever as she will always have some bacteria in her urine which need not be treated unless the patient is symptomatic and I would try to avoid getting her to a stage where only very expensive antibiotics will work
Answered: Fri, 22 Nov 2013
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