Another UTI: This time I'm resistant to Macrobid and Cipro...

[Theophania]

...so they put me on Nitrofurantn.

I'm scared. What if nothing works on me?? How many more UTI antibiotics exist before I'm resistant to everything? Anyone know?

I'm thinking I'm going to use a new catheter everytime I pee from now on. I am too scared I'm going to die young :(

[Jadis]

which bug do you have? Make sure you are taking them right... 3x a day means every 8 hrs, not 3x while you are awake. Once a day SR antibiotics need to be taken at the same time every day.

Are you taking the Nitrofurantoin two or 4 times a day?

[Le Type Français]

Theo,

Your resistance only means the bacteria affecting you now is resistant, not that Cipro will never work for you again.

Hope this helps.

Todd

[lynnifer]

I want to say prevention is the way to avoid this ... but I'd sound like a hypocrite since I don't cath.

[SCI-Nurse]

Well, now I am confused. Macrobid IS Nitrofurantoin, so it sounds like you are on an antibiotic that will not be effective for you. Have you been taking routine Microbid? This would explain the resistance you have developed. Microbid is technically a urinary antiseptic, not an antibiotic, and is rarely effective for resistant bacteria anyway.

What did your sensitivity show as the BEST antibiotic for this bug? When you say infection, are you talking about a positive culture, or do you also have a fever/chills, severe spasms, malaise, AD, flank pain, etc?

(KLD)

[Wise Young]

...so they put me on Nitrofurantn.

I'm scared. What if nothing works on me?? How many more UTI antibiotics exist before I'm resistant to everything? Anyone know?

I'm thinking I'm going to use a new catheter everytime I pee from now on. I am too scared I'm going to die young :(

Theophania, what you ask is a nightmare for many physicians. People usually classify antibiotics by their mechanisms of action (e.g. penicillins, cephalosporins, fluoroquinalones, tetracyclines, macrolides, aminoglycosides) but bacteria showed their verstility when they not began to develop resistance to multiple antibiotics at a time but were able to transfer the genes for multiple resistance in one fell swoop (Source (http://www.healthatoz.com/healthatoz/Atoz/ency/antibiotics.jsp)). So, now, doctors are beginning to classify antibiotics by their action on different bacteria Source (http://www-users.med.cornell.edu/~spon/picu/referenc/antibi98.htm)).

The problem is that bacteria will develop resistance to any antibiotic, if we expose enough bacteria to the antibiotic. Class III antibiotics are those that require physicians to consult with an advisory source before prescription (Source (http://www-users.med.cornell.edu/~spon/picu/referenc/abxcl99.htm)). These are antibiotics that should be sparingly used and only when necessary, so that we do not breed resistant bacteria.

The way that I think we should use antibiotics is what I call a "sucker punch" approach. You first lead with a Class I broad spectrum antibiotic to winnows down the herd to a few bacteria and then hit them with a Class II and Class III drug to deliver the knock out punch. The worst thing to do is to keep hitting with a Class III antibiotic and have nothing left to punch with when the bacteria learns how to defend itself.

Very unfortunately, farmers have been using potent antibiotics for decades in feed. For example, chicken farmers use an fluoroquinolone antibiotic called Baytril in chicken feed because they found that this increases the average weight of their chicken. In doing so, they have created bacteria that are resistant to most fluoroquinolones, including Cipro. Doctors also have been guilty of leading off with Cipro as the first antibiotic of choice to treat bladder infections. In doing so, they are limiting the usefulness of Cipro, and the reason why it is not working for many people.

Some 25-30% of bacteria are turning out to be resistant to common antibiotics. Many scientists are alarmed by the decreasing discovery rat of new antibiotics. As opposed to a decade or two ago, when multiple antibiotics were being discovered every year, few new classes of antibiotics are being discovered. One new one that was discovered recently is a peptide discovered in the fungus found on Northern European pine trees (Source (http://www.eurekalert.org/pub_releases/2005-10/gumc-nco100605.php)).

Many clinicians now have begun to use a method called antibiotic cycling, i.e. giving different classes of antibiotics for varying lengths of time. Some have begun to cycle multiple "cassettes" of antibiotics (Source (http://jac.oxfordjournals.org/cgi/content/full/55/1/1)). Some clinical trials have suggested that this approach is more useful than others.

Wise.

[Le Type Français]

Dr. Young,

That is interesting you mention that. My urologist always prescribed Cipro as the first defense. Another doctor a little over two weeks ago gave me Cipro ear drops to fight an infection.

[SCI-Nurse]

Cipro is the poster child for overused, overprescribed antibiotics. Too many physicians just prescribe it for everything without getting cultures and sensitivities, and using older, just as good antibiotics appropriately. This has resulted in MANY stains of Cipro resistant bacteria in hospitals and in the community....it explains nearly all of the MRSA we see today.

Here is a timely article from today's NY Times:

http://query.nytimes.com/gst/fullpage.html?sec=health&res=9F07EED6123EF93AA25753C1A9679C8B63

(KLD)

[sjean423]

Cipro is the poster child for overused, overprescribed antibiotics. Too many physicians just prescribe it for everything without getting cultures and sensitivities, and using older, just as good antibiotics appropriately. This has resulted in MANY stains of Cipro resistant bacteria in hospitals and in the community....it explains nearly all of the MRSA we see today.

(KLD)
I am changing urologists for exactly this reason. My last UTI she took 2 days to return my call, and was going to prescribe Cipro without any lab work. In the meantime I got fed up (and sicker) and called my GP, who ordered lab work (and in the end I took Cipro anyway, because the Bactrim gave me hives, but at least we knew it was the correct action). I don't have a lot of faith in this urologist anymore.

[paramoto]

My doctor prescribes Nitrofurantoin a lot. He also has prescribed antibiotics without a culture/sensitivity test, which I now totally refuse. I don't have access to too many other urologists where I live. I have had high leucocytes (15-20) and colonization for around four weeks now, started developing a little fever last week and took Nitrofurantoin twice a day and now my leucocytes are down to 2-4, which is low/normal for me and no colonization was detected. I know self medication is really bad, but I started with what I understand is the lowest possible antibiotic and it worked, instead of cypro which is what my doctor prescribed for me to take one month ago (the bacteria showed to be sensitive to Cypro in the sensitivity test I did at that time).

[canuck]

My GP has been prescribing a anitbiotic when I go initially but always changes to something else if culture indicates the first drug isn't going to be effective. My problem is a lot of antibiotics give me diarhea so we are restricted somewhat during the summer months when I'm working. That being said I've been doing this for nearly 37 years & have never had to resort to I.V antibiotics yet. Just because a culture is resistant to a few drugs doesn't mean the sky is falling. That's the whole reason for the culture to determine what bacteria is growing & what drugs are best.

[hank70]

I had a nasty bug awhile bag that was resistant to Cipro and Levaquin. The Cipro helped but wouldn't kill it all. After a culture they gave me Keflex for 10 days to knock it out and started me taking Uroquid Acid. I have not had any problems since then which was almost a year ago. I am also drinking green tea daily mixed with unsweetened cranberry extract.
http://www.vitaminshoppe.com/store/en/browse/sku_detail.jsp?id=TR-1001

I hope to not have to deal with a lengthy high fever again. That's the worst feeling. Hope you feel better soon.

[Theophania]

thx everyone for the replies.

the first culture they did 2 weeks ago revealed i was resistant to marcobid.

last week's culture revealed i was resisted to cipro, but not macrobid (that was afterf 1 week of taking cipro, btw).

wtf? i'm so confused. so now im on nitrofaurntn (sp?). have been since monday. i was feeling better on weds, but now today (thurs), i feel feverish again and more spastic. maybe its not working?

[john smith]

I am going to add to this thread our most recent experience. I hope it clarifies some of our questions and some of the overall confusion that comes with UTIs.

Last night, Noah wakes us up. He is shivering uncontrollably. We suspect a UTI, head to the ER for a culture and prescritption. They just use a dip to determine infection and prescribe Levaquin; a five day dose of one a day at 250 mg.

It has been two years since Noah has taken any antibiotics for a UTI. Like many who are paralyzed, he lives with a low grade infection that is seldom symptomatic beyond reduced energy.

Anyway, we wonder: is this prescription strong enough and is the length of the prescription sufficient at just five days to kick the infection? Where does Levaquin fit in the class 1,2, 3 categories?

He still feels pretty puny today but it is not yet 24 hours since his first dose. He gets a killer headache whenever he pees that is short lived. Appetite is decent. Mostly, we wonder about the dosage and length of the script.

John

[Clipper]

John,

Levaquin is in the same class of antibiotics as Cipro. The 250mg is the lowest dosage, and once a day is normal. Make sure he's taking it two hours before or two hours after antacids to maximize its effectiveness.

Make sure you call the hospital lab to get the results of the culture. It's entirely possible that the bacteria Noah has is not sensitive to Levaquin. The bugs I get aren't kiled by Levaquin or Cipro. Even after I get the culture back, I always ask what the count is. I know what's "normal" for me, so the "infection" isn't treated unless I'm symptomatic and/or the count is way high. See my post in the thread "Fear" to read more about my recent experiences.

[lilsister]

John and/or Noah, if there is headache present at each void, maybe the blood pressure should be checked at that time, to rule out episodic AD. Possibly it is a kidney stone? Just a thought, although headache may be "normal" when he has an UTI. Definitely need to follow up the culture. At any rate, hopefully all the UTI-ers will soon be feeling better!

[john smith]

Thanks Clip. it is good to hear from you. We will follow up on the culture. He starts back to school on Monday. The summer sessions are intense and he can't afford to miss classes.

John :)

[betheny]

Also, Noah only got a 5 day script of Levaquin...not long enough imo. Definitely follow up on that, because I've always been given 7 or 10 days.

[SCI-Nurse]

Dip-stick tests are totally worthless in people with SCI, as it only tests for bacteria, is not specific for UTI (just colonization), and does not test of drug sensitivity. I hope they also did a C&S which is what is really needed. Be sure to call and find out if they did this test today. They treated him as you would an AB with an ordinary UTI, which is not correct.

Also, for someone with SCI, all UTIs are to be considered complex UTIs, and should be treated for 10-14 days, not 3-5 days. Contact his SCI urologist or physician for guidance on this today.

(KLD)

[john smith]

Thanks Kathy;

That was what we were wondering; if perhaps he was treated without consideration for his SCI. We are trying to get in touch with his SCI urologist and Physiatrist from RIO. We became suspicious about the 5-day script.

John

[Rollin Rick]

thx everyone for the replies.

the first culture they did 2 weeks ago revealed i was resistant to marcobid.

last week's culture revealed i was resisted to cipro, but not macrobid (that was afterf 1 week of taking cipro, btw).

wtf? i'm so confused. so now im on nitrofaurntn (sp?). have been since monday. i was feeling better on weds, but now today (thurs), i feel feverish again and more spastic. maybe its not working?

Theo,

I am going through the exact same thing that you are. I started out with cipro for 10 days, started feeling better on the third day and then just went downhill quite quickly. I went back to the emergency room to have everything checked out along with a culture. They sent me on my way which seven days of Macrobid. I started feeling pretty good this Wednesday and Thursday, now today I'm going back downhill. Now my doctor has my culture saying she wants me to go back to the ER for IV antibiotics?? Now I'm really starting to get frustrated and very nervous, I just don't know what to do now. Just thought I would share my story, good luck.

[buckwheat]

I am also taking acidopholous while taking Levaquin in order to keep the good cultures in my body. Is there any risk that this would dampen the effects of Levaquin or provide a home for the bacteria that I'm trying to get rid of?

[hank70]

John,

Levaquin is in the same class of antibiotics as Cipro. The 250mg is the lowest dosage, and once a day is normal. Make sure he's taking it two hours before or two hours after antacids to maximize its effectiveness.


I think I've asked this on the forums before but failed to check back. If you are taking Uroquid Acid or an antibiotic like Cipro would Prevacid counteract the drug? Just curious if Prevacid effects your urine acidity? I take Prevacid when I have terrible reflux.

[SCI-Nurse]

H2 blockers work differently than antacids. There should be no problem taking an H2 blocker (Tagamet, etc.) at the same time as an antibiotic or urinary antiseptic.

(KLD)

[Broknwing]

H2 blockers work differently than antacids. There should be no problem taking an H2 blocker (Tagamet, etc.) at the same time as an antibiotic or urinary antiseptic.

(KLD)

Is Aciphex also an H2 blocker? I take it for Silent Reflux and to manage polyps on my vocal chords. If it's not an H2 blocker, or an antacid, what exact category of drug does it fall into? THX


ETA:sorry Tiff for the minor thread hijack...

[SCI-Nurse]

Yes, that is also an H2 blocker. These medications reduce your production of acid in the stomach. They don't neutralize the acid already produced, which is what an antacid does.

(KLD)

[hank70]

H2 blockers work differently than antacids. There should be no problem taking an H2 blocker (Tagamet, etc.) at the same time as an antibiotic or urinary antiseptic.

(KLD)


Thank you for this information.

[KateM]

Hey Theo!
I sympathize with you a great deal. I was plagued by UTIs constantly for a long time (it felt like every month I was on an antibiotic), and I was terrified that one day I would be 'immune' to all the antibiotics. I have always IC, and I use a new, sterile catheter each time.
Anyways, a couple or three years ago I read on the CC site about the advantages of high doses of vitamin C. I thought 'why not, it can't hurt'. I mentioned it to my GP, and she reiterated what I had read here: vit C makes your bladder very acidic, hence bacteria cannot adhere to it.
Long story short -- I haven't been on anitbiotic since I started this. I take about 2500mg per day (1250 morn/1250 eve). If I ever get any uti symptoms (for me it's incontinence), I up my dose of vit c for a day or two. When this happens, I do take my urine in for a culture, and 95% of the time, my doc calls and says she found small amounts of bacteria, but if I don't want to be on antibiotics, to just drink lots, cath regularly, and if I get any regular symptoms to call her.
Just thought I'd tell you my story. If this, for you, is a case of 'been there done that' , then I'm sorry I can't help.
I hope you find answers to your very frustrating situation.

[JGNI]

H2 blockers work differently than antacids. There should be no problem taking an H2 blocker (Tagamet, etc.) at the same time as an antibiotic or urinary antiseptic.

(KLD)

Prevacid is NOT a H2 antagonist (not to be confused with Pepcid), it is a PPI (proton pump inhibitor, same family as Nexium, Prilosec and so on), but again there is no problem with taking a PPI or a H2 antagonist with a fluoroquinolone like CIPRO or LEVAQUIN.

buckweat, taking probiotics (lactobacilli, bifidobacteria, saccharomyces boulardii etc) with your antibiotics will not significantly impair the antibiotic activity and could help to maintain a healthy intestinal flora and avoid antibiotic related diarrhea.


john smith, as others said, 5 days is short for SCI patients (there may be exceptions though), but on top of that 250 mg is a low dose. In North America Levaquin is prescribed once a day but in Europe it is most of the time twice a day, I personally don't trust too much Levaquin, even less at 250 mg, even less once a day, even less for 5 days ;)

Theophania, don't worry too much about "what if there is no antibiotic", it will not help you (I know, we all have this reflex). It is not because you once had bacteria that were resistant (bacteria can be resistant to antibiotics, not you) to a certain antibiotic that all the others will be resistant to that antibiotic too, your last results are a proof of that. In order to avoid major problems, it is important to treat an infection FAST before it turns too bad, so if you know that you are prone to bad infections it is important to always be aware of the early signs and act accordingly with your physician. I am not saying that asymptomatic infections/colonization should always be treated with antibiotics, we all know better, but too often some people are saying "I don't feel good but I will wait a bit longer and see if I can go through without antibiotics ..." and they end up with major problems. Again, I am not saying that a little wait to see if it is really heading toward problems is never a good idea, I think you get the point ... it's a fine balance that needs to be tuned for each of us.

Finally, I wrote it in the past, some antibiotics, like Cipro, really concentrate themselves in the lower urinary tract (bladder ...) when eliminated by the kidneys. Reaching higher concentrations where you need it in a UTI, culture sensitivity can sometimes be misleading because it tells you when a bacteria is sensitive in certain conditions that are not the same as those that will be achieved in the bladder. In brief, sometimes the culture can say that the bacteria are resistant but the antibiotic can still get rid of your UTI.

[Theophania]

thx every1 for your help. the vitamin c advice is great stuff!

my uro nurse told me yesterday to start taking a cran pill before bed each night so it has all night to "stew" in my bladder. im going to try that too. she also told me to prevent sex-related uti's that i should buy a squirt bottle and squirt around my urethra be4 anbd after sex since i dont pee through there anymore.

the nitrofaurtn worked, i think (waiting on culture). i finally feel better! my dr gave me a script of septra to take in the future when i feel a uti coming on.

[Cherry]

she also told me to prevent sex-related uti's

uggh theyre such a pain in the ..... It got so bad and unavoidable lately we just use something every time....mind you i used to get related cystitis now and then pre accident anyhow, but theres no way I'm giving sex up ;)

Seriously, consider d-mannose too, seems to help for me

good luck missus

[Theophania]

whats d-mannose?

[Cherry]

http://www.healingtherapies.info/D-Mannose.htm

If you google for it you can buy pills or powder form