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Thread: Putting antibiotic pills in bladder?

  1. #1
    Senior Member ~Lin's Avatar
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    Putting antibiotic pills in bladder?

    I know I've read somewhere around here about someone who places actual antibiotic pills into their bladder. The ones meant for oral consumption. How do you do that? Is it safe? Being as it's meant to go to the stomach and not bladder. Is it actually effective? What about comparison to say gentamicin bladder instillation that's MEANT to go into the bladder? Why do it will the pills instead of gentamicin, is it a cost/acquiring gentamicin issue?

    Obviously this is an off label use. I'm looking for responses from the people who actually do it. I don't think anyone in the medical field would recommend it...
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  2. #2
    Senior Member bigtop1's Avatar
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    I occasionally will lube a catheter with a small amount of triple antibiotic ointment. The heavier base ointment makes for easier insertion. Never had any untoward reaction of sorts. In my mind, I guess it helps to ward off infections. Mentioned this practice to my urologist and it didn't seem to upset her. She just said it may be of benefit in sliding the cath in.
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  3. #3
    Senior Member darty's Avatar
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    I have in the past dissolved an antibiotic pill into a large bottle of saline. Then use that saline to irrigate my bladder. I used about 40 cc and clamped off the catheter for about 10 minutes.
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  4. #4
    Senior Member ~Lin's Avatar
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    I have a suprapubic catheter so I don't have to insert a cath, it's always in. I have a script for gentamicin antibiotic instillation but it doesn't last the full month if I'm fighting off an infection. I wondered about dissolving a cipro and using it, I try to avoid oral antibiotics for the systemic reasons plus I have a lot of GI problems that the antibiotics make worse. I have lots of sterile saline syringes because I also have a central line. I was worried about the other ingredients in the pill not being meant to be in the bladder though vs the gentamicin which IS meant specifically for the bladder....
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  5. #5
    Quote Originally Posted by bigtop1 View Post
    I occasionally will lube a catheter with a small amount of triple antibiotic ointment. The heavier base ointment makes for easier insertion. Never had any untoward reaction of sorts. In my mind, I guess it helps to ward off infections. Mentioned this practice to my urologist and it didn't seem to upset her. She just said it may be of benefit in sliding the cath in.
    I have some unsolicited advice for you, bigtop1.

    Don't do this.
    https://www.ncbi.nlm.nih.gov/pubmed/18664609

    The three antibiotic medications in triple antibiotic ointment aren't great for killing UTIs. If you're intermittent cathing you definitely have some bacteria in your bladder, if the current mix isn't causing you problems (fever, pain, spasms, frequency, smell, etc) then you're likely to disrupt the current biome and let a resistant bacteria take over. The article I listed above points out that therapeutic doses of polymyxin B (one of the three antibiotics) are quite toxic, requiring dialysis for several patients prior to administration. If you take just a touch of the antibiotic you're just selecting for the bacteria that are resistant to it.

    Of the medications in it, one is not effective against the usual suspects in the bladder (it treats the wrong gram type of bacteria), the other two have not been used to treat urinary tract infections except those that have been proven to be sensitive to those particular agents, and even then only in extremely rare and dire circumstances (for example 5/16 patient's in the polymyxin study died before it was over) because of the concern for creating multi-drug resistant bacteria.

    I wasn't able to find any evidence of how bladder injection of these medications would affect their efficacy, but best case scenario you're using doses far too small and for too limited of a time (because you're about to empty your bladder anyway) to cause any effect. There is no upside, if you happen to be getting adequate doses this way you're going to have a pretty good chance of brewing some multi-drug resistant bacteria in your bladder that will be resistant to some of the big guns that we reserve for extreme cases. Likely you're doing little more than inflaming the mucosa of your urethra with an ointment that specifically says on the label "for external use only" and has warnings about using in and around the eyes and nose (they probably didn't think of people using it on their urethra and bladder).

    Anywho, I'll stop rambling. Just my advice, what do I know?

  6. #6
    I suppose it would depend on the antibiotic. Some (if not most?) oral antibiotics have to be metabolized or "activated" by CYP450 enzymes from the liver as it passes through the gut and Cipro is one of those. Funny enough, supposedly 40 to 50% of Cipro is excreted unchanged in urine (meaning your body didn't process it and it's just going out as trash, so by putting pills in your bladder you're essentially trashing 100% of it instead lol). That percentage is not what fights the infection though, the part that was metabolized and not excreted in urine does. So I'm not sure what instilling oral Cipro in your bladder would change since it's inactive. Not to mention that oral meds aren't sterile or meant to be administered (or even designed to work) by any other route and you're risking introducing some more bacteria in your bladder. You don't know what kind of fillers they put in along with the pills (changes with every company), do you want to put that in your bladder and potentially cause a reaction? Especially when some people have chronic cystitis and UTIs? Maybe that's just me. Also gentamycin flushes are usually prepared in the same way as IV bags so that they're sterile. I don't know about you but I know if I'm trying to prevent infections or treat an early infection, injecting non-sterile stuff in my bladder isn't the best choice. It's actually kind of stupid and completely useless in my opinion.

    The reason they prescribe Gentamycin (or Tobramycin) bladder flushes is because if taken orally these two are excreted in the urine via kidneys as unchanged *active* molecules, meaning they pass right through you without being absorbed and are pretty useless orally (and why they're given IV or IM). But that makes them useful for local use in the bladder, the drug is already active and ready to go, doesn't need to pass through your gut and be converted by your liver so it can go directly in your bladder and get to work (vs. a large percentage of Cipro that gets trashed out in *inactive* form). So, whether you swallow it or instill it directly, it's still in the same (or similar) form from what I gather (and why it's one of the few that can be used in the bladder and isn't given orally because it's useless). But that's specific to gentamycin. Like I said, Cipro needs to be converted by the liver. Putting it directly in the bladder in inactive form would probably do absolutely nothing.

    Keeping that in mind, if the UTI in your bladder is slowly creeping up to your kidneys, I suspect (proper) bladder flushes won't kill it completely because it doesn't go past the bladder - you're probably better off with oral/IV/IM antibiotics. Actually my urologist explained to me that bladder flushes actually just kill the bacteria that's floating in your bladder/on the surface, and not the deeper infection, and this was certainly my experience with it. I liked the idea of bladder flushes because hey, you don't have to have your whole body exposed to antibiotics, deal with the side-effects and flushes supposedly don't tend to cause much risk of resistance, so it sounded like a perfect way to prevent infections, even if costly. I don't know I just haven't had much luck with it. I know you have gut issues so it sounds like a terrific idea but um, yeah.

    I mean, I didn't extensily study the in-and-outs of how Cipro is metabolized so maybe there's a minuscule chance that it helps. Likely not though. There's a reason why they mainly use gentamycin or tobramycin for direct use in the bladder, think about it. And even then that's controversial...if it was absolutely effective/practical it would be more common and not a last-ditch effort in rare cases. I've tried both gentamycin and tobramycin. It did help if caught at the right time, but if not it just delayed the inevitable by a few days in my experience (or false negatives on C&S early on, just delaying treatment). I haven't tried putting pills in my bladder, so I guess I can't answer why someone would? Probably because they don't know what I explained above? I can see the cost of gentamycin being an issue for sure, it's expensive. It was also on backorder for a year nationwide here about 2 years ago (why I had to switch to Tobramycin) so that could be another reason.
    Last edited by twistties; 11-06-2017 at 02:48 AM.

  7. #7
    Quote Originally Posted by twistties View Post
    Keeping that in mind, if the UTI in your bladder is slowly creeping up to your kidneys, I suspect (proper) bladder flushes won't kill it completely because it doesn't go past the bladder - you're probably better off with oral/IV/IM antibiotics. Actually my urologist explained to me that bladder flushes actually just kill the bacteria that's floating in your bladder/on the surface, and not the deeper infection
    I agree with everything above by funklab and twistties. Reckless use of drugs in ways in which they were not investigated scientifically either during or after their development in rigorous clinical trials and for which they are not approved or even have warning against certain uses is putting your health and perhaps even your life at risk.

    Most UTIs that require treatment (ie, symptomatic UTIs that include fever, chills, malaise, etc.) involve your kidneys. Unless you have very incompetent ureterovesicular valves (between your ureters and bladder) and have complete reflux of urine (and possible hydronephrosis) urine and medications in your bladder will not reach your kidneys. If they do, it is possible that they could damage your kidneys much more severely than a UTI.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  8. #8
    Senior Member bigtop1's Avatar
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    I am certainly well aware of the flooding of antibiotics and, their eventual effectiveness upon certain bacteria. That being said, I occasionally feel a bit of rawness in my urethra. When this occurs, I will coat, just coat the catheter with an antibiotic ointment to decrease the harshness as inserting. It is my sincere opinion that the ointment amount, if any, will end up in the bladder to be excreted. I used the word triple antibiotic as an example only. In fact, I am using some bacitracin that is in the tube. As I mentioned in my post, I have never had a reaction of any sort (good or bad). I guess the key word here is moderation. Now, if I were to, on purpose, trying to instill something in the bladder, I would probably use a syringe or, an adapter to the end of the cath to do so. I can understand everyones concern for bacteria(bugs) that we confront everyday. I feel that the bodies response to infection does a good job of ridding itself of it. I also know that colonization is another method of the body to deal with. bacteria. Now, sepsis is another matter and condition entirely. The use of a benine substance helps me get over this roughness I mentioned. I do not condone the use of anything being inserted into the bladder without a physicians approval.
    I refuse to tip toe through life, only to arrive safely at death.

  9. #9
    Urethral use of triple antibiotic ointment has not been scientifically researched for safety, which is why you will see the warning to avoid ANY internal use on the tube. The bacteriocidal chemicals in surgical lubricant have been research for this, so I would strongly recommend that you limit your use of only these for catheterization. You risk damage to the mucosal lining of the urethra, and systemic absorption of some chemicals can occur from the urethra as well as the bladder.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  10. #10
    Quote Originally Posted by bigtop1 View Post
    I am certainly well aware of the flooding of antibiotics and, their eventual effectiveness upon certain bacteria. That being said, I occasionally feel a bit of rawness in my urethra. When this occurs, I will coat, just coat the catheter with an antibiotic ointment to decrease the harshness as inserting. It is my sincere opinion that the ointment amount, if any, will end up in the bladder to be excreted. I used the word triple antibiotic as an example only. In fact, I am using some bacitracin that is in the tube. As I mentioned in my post, I have never had a reaction of any sort (good or bad). I guess the key word here is moderation. Now, if I were to, on purpose, trying to instill something in the bladder, I would probably use a syringe or, an adapter to the end of the cath to do so. I can understand everyones concern for bacteria(bugs) that we confront everyday. I feel that the bodies response to infection does a good job of ridding itself of it. I also know that colonization is another method of the body to deal with. bacteria. Now, sepsis is another matter and condition entirely. The use of a benine substance helps me get over this roughness I mentioned. I do not condone the use of anything being inserted into the bladder without a physicians approval.
    While I certainly wouldn't call it benign, using bacitracin on your urethra is less likely to cause multi-drug resistant organisms, because pretty much all of the drugs that cause common UTI's (and therefore urethral infections) are resistant to this drug already. Still seems a bad idea to me, but to each his own I guess.

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