UTI question, this is confusing

[Rollin Rick]

Back in November, my doctor put me on the antibiotic Bactrim, even though I was feeling just fine as I told her that, she said, it's a slow growing bacteria and you won't be feeling fine before long. So anyways, I have been taking this for the past five months(considered chronic UTI), obviously, it's a nasty bug?? So I figured after five months I wanted to take another urine specimen when I did my catheter change. I had this done on Thursday and now I received a phone call from the doctor's office today (Saturday) saying that called in a prescription to my pharmacy for Cipro..... What is the deal with this?? My home care agency talk to my doctor and told me to take both antibiotics.... Is there something wrong with this picture or no? I feel absolutely fine, no blood in my urine, no odor, perfectly clear, no A.D., temperature etc. I don't know what to do, should I listen to my doctor? Being a Saturday, this was the on-call doctor prescribing this. I was thinking waiting until Monday to talk to MY doctor. Any suggestions?

[SCI-Nurse]

You have an indwelling catheter, right?

Is your doctor a urologist who specializes in SCI or neurologic urology? If you were placed on Bactrium for treatment, you would have been on it for only 10-14 days. If your doctor put you on it for months, they are trying to use it for prophylaxis (prevention) and what has probably happened is that your bug is now completely resistant to Bactrium. This is one very good reason to NOT take prophylactic antibiotics.

Did you have symptoms (leakage, flank pain, fever, chills, malaise, etc.) when you sent in the recent specimen? If not, why did you get a culture? On Bactrium a culture and sensitivity will be worthless. You have to be off antibiotics completely at least 3 days for it to be valid. How long does the doctor want you on Cipro? While it will not hurt you to take both of these meds, I doubt it will help you either, and long term use of either or both can be a problem.

You (not the nurse) needs to talk to the doctor and find out why they are treating your colonization, which is NOT recommended for people with SCI, esp. those with indwelling catheters. Print out and give these document to your doctor, ask them to read them, and then discuss with you their approach to management of colonization vs. UTI in people with paralysis.

http://www.ahrq.gov/clinic/epcsums/utisumm.htm (although this has a note on it saying it is outdate, that is NOT the case and it still forms the basis for management by expert SCI physiatrists and urologists)

http://www.pva.org/site/News2?news_i...rticle&id=7121

(KLD)

[jody]

so how do you treat it then? if no antibiotics? I have been on bactrim for years, and this one is resistant to cipro, macrobic leviquin, and they just upped my bactrim to twice a day, changed my caths to kits, and to six times a day. my dr is not a sci urologist, but a good DR. the films look bad. Hydronephrosis. I have been wondering too about this bug. it is like no other, so maybe his doc knows about this bug I have been hi-jacking threads about. Sci nurse, do you know anything about a super uti bug? I got some weird vibes at the urologist this week, what is up? I have been reading that a lot of us cant get rid of a restant uti. is there something we can do?

[SCI-Nurse]

Over use of antibiotics is the major cause of superbugs (MRSA, VRE, c. diff., etc.) that can cause a wide variety of infections (wounds, skin, urine, lungs). Physicians who throw antibiotics at urinary colonization in people with SCI need to look at clinical practice guidelines as above, treat only for true UTI (with a few exceptions) and avoid use of antibiotics (esp. broad spectrum ones) unless really indicated.

(KLD)

[Oldtimer]

Originally Posted by Rollin Rick

Back in November, my doctor put me on the antibiotic Bactrim, even though I was feeling just fine as I told her that, she said, it's a slow growing bacteria and you won't be feeling fine before long. So anyways, I have been taking this for the past five months(considered chronic UTI), obviously, it's a nasty bug?? So I figured after five months I wanted to take another urine specimen when I did my catheter change. I had this done on Thursday and now I received a phone call from the doctor's office today (Saturday) saying that called in a prescription to my pharmacy for Cipro..... What is the deal with this?? My home care agency talk to my doctor and told me to take both antibiotics.... Is there something wrong with this picture or no? I feel absolutely fine, no blood in my urine, no odor, perfectly clear, no A.D., temperature etc. I don't know what to do, should I listen to my doctor? Being a Saturday, this was the on-call doctor prescribing this. I was thinking waiting until Monday to talk to MY doctor. Any suggestions?

It sounds like you do have a UTI and I would go with the Cipro. I take Bactrium when I feel it is needed (PRN) and have very few infections but at times will get one that the bactrium won't kill. I do self cath, 5 months sounds like a long time before changing (unless I am reading wrong). A UTI can come from many things, not enough fluids, dirty cath, being in the same position for long periods of time, etc. I believe it is different in everybody and until you get to know your body it could be difficult knowing that you have a UTI. Good Luck!

[thehipcrip]

Rick,

I gotta respectfully disagree with Oldtimer. Since you are having no symptoms whatsoever, what you have is colonization, not a true UTI, and you should not be taking *any* antibiotics at this time.

These doctors are behaving as if you are an AB and are trying to clear all the bacteria out of your urinary tract. But because colonization is pretty much the status quo for people with SCI (especially those who use indwelling catheters), that's never going to happen. So they keep prescribing and you keep taking, and eventually the bacteria that are present become resistant to the drugs, creating more and more super bugs. And when you do get a real infection (in which you have both >100,000 bacteria colonies present *and* symptoms like flank pain, leakage, fever, chills, malaise, etc.), there are fewer treatment options and more aggressive treatment may be required (e.g. IV therapy). In addition, you may develop adverse reactions to the antibiotics.

I speak from experience. After battling UTIs for years, I started taking a daily dose of Macrodantin as a UTI prophylactic (this was years before I started using an indwelling catheter). I ended up developing an allergy to the drug which caused two different forms of lung disease. And although I never took it as a preventive, only as a treatment for full blown UTIs, I also developed an allergy to sulfa drugs out of the blue -- took them without problems for years, then one day ended up in the ER covered in giant hives and unable to breathe after taking one dose. Needless to say, being allergic to these drugs severely limits my options for treating serious infections (urinary, lung, etc.). As more and more strains of bacteria become antibiotic-resistant because the drugs are overprescribed by doctors and taken incorrectly by patients (e.g. taking one here and there "when you feel it is needed"), I'm having to resort to IV/IM antibiotics more and more frequently to treat my full-blown infections.

Rick, I hope you will take KLD's advice. If I were in your chair, I would stop taking the Bactrim altogether, and not even start the Cipro unless your regular doctor can convince you that it's absolutely necessary in the absence of any other symptoms -- say, for example, to treat a really nasty strain of bacteria like pseudomonas a.

Likewise, jody, I urge you to consider dropping your daily dose of sulfa drugs.

--THC

[Rollin Rick]

Originally Posted by SCI-Nurse

You have an indwelling catheter, right?

Is your doctor a urologist who specializes in SCI or neurologic urology? If you were placed on Bactrium for treatment, you would have been on it for only 10-14 days. If your doctor put you on it for months, they are trying to use it for prophylaxis (prevention) and what has probably happened is that your bug is now completely resistant to Bactrium. This is one very good reason to NOT take prophylactic antibiotics.

Did you have symptoms (leakage, flank pain, fever, chills, malaise, etc.) when you sent in the recent specimen? If not, why did you get a culture? On Bactrium a culture and sensitivity will be worthless. You have to be off antibiotics completely at least 3 days for it to be valid. How long does the doctor want you on Cipro? While it will not hurt you to take both of these meds, I doubt it will help you either, and long term use of either or both can be a problem.

You (not the nurse) needs to talk to the doctor and find out why they are treating your colonization, which is NOT recommended for people with SCI, esp. those with indwelling catheters. Print out and give these document to your doctor, ask them to read them, and then discuss with you their approach to management of colonization vs. UTI in people with paralysis.

http://www.ahrq.gov/clinic/epcsums/utisumm.htm (although this has a note on it saying it is outdate, that is NOT the case and it still forms the basis for management by expert SCI physiatrists and urologists)

http://www.pva.org/site/News2?news_i...rticle&id=7121

(KLD)

KLD,

I just printed out the information and it's ready for the mailbox, thank you.

Yes, I have a suprapubic catheter. What happened was, they said I had a bug that would be difficult to treat, so, they put me on Bactrim twice a day for 14 days and after that one a day at bedtime. At the time I started this I felt perfectly fine. Now the reason why I wanted to take my recent specimen is because I wanted off of the antibiotic. My specimen was taken this past Thursday during my catheter change, at that time I felt perfectly fine as well. I did pick up the Cipro, but I am not taking it until I talk to my doctor on Monday. Now with all of this going on, it figures I'd wake up at 3 a.m. feeling kind of cold and my pain being kicked up a notch, I sure hope it's just anxiety and not a TRUE UTI... They put me on Cipro 10 days. So tomorrow I will talk to the doc, I'm going to tell her I'm dropping these antibiotics until I have symptoms.

[Rollin Rick]

Thehipcrip,

Thanks for the write up, quite the story. Nice to hear from someone who has been there and back.

I'm definitely following KLD's advice. This is ridiculous...

And thanks to you oldtimer.

[Oldtimer]

I say to go with the new drug because a specimen was taken and it usually takes 48 hours to tell what drug works on what bug. Being the Dr. called on Saturday (very unusual) makes it 48 hours and it sounds like they have matched the right drug for the bug. Hopefully it is as simple as a bug. Good luck!