Monday, December 5, 2022

Uti Long Term Antibiotic Treatment

Short Course Antibiotics For Uti Treatment

Long Term Antibiotic Treatment Safety in Chronic UTI with Professor James Malone-Lee

When prescribed an antibiotic for uncomplicated UTI treatment, the course duration will usually be 3, 5 or 7 days , depending on the antibiotic prescribed. Single dose antibiotics, such as Fosfomycin , are also prescribed in some cases.

Common short course antibiotics are listed in our UTI antibiotics section, with their potential side effects. We wont go into detail here for the following reason

Short courses of antibiotics are not designed for recurrent UTI treatment. Particularly not those recurrent UTIs that are caused by an underlying bladder infection that has been around for months or even years.

Targeting The Biggest Player First

Ruth: My approach is to see who is the big player which infection is the highest amount on one of these reports and target the biggest part of the problem. Now bacteria kind of are classified in a couple different categories: Gram-positive, which has to do with the type of stain they take when you put it on a microbiology slide and look at it under a microscope, or Gram-negative.

Most antibiotics address either Gram-positive or Gram-negative bacteria. Theres only a few that will kind of do an okay job with both. By selecting which antibiotic is the best one for the majority of the infection thats come out of the biofilm currently, is going to knock back the most infection.

And when we knock that one back, because the biofilms have lots of inhabitants, lots of different bacteria, then we retest and see whos the next biggest player thats now causing the most problem and we go after that one. This necessitates that you treat each infection that comes out.

And I like to do, most protocols are two weeks long. Its a little bit longer than youd routinely be given for an acute infection because the acute infections havent gotten as embedded. And yet its not long term because if you give only one antibiotic long term and the other infections arent covered by that one antibiotic youre given long term then its not going to work.

Use Of Oral Antibiotics Reactions And Side Effects

Antibiotic use is widespread. As we know, used properly, antibiotics manage life-threatening infections, but as with any chemical compound sides effects can occur.

NHS England explain the most common reactions to antibiotics.

Always tell your specialist of previous reactions or allergies to medications during your consultations. Explain any other health issues that may be impacted by the use of antibiotics and if you are already prescribed antibiotics or other medications for separate health conditions.

Your specialist should explain possible side effects of your prescription during your appointment and your pharmacist can provide further information. Its always worth also reading the patient information leaflet provided with your medication.

Any medication has possible side effects. You should tell your specialist about any side effects and reactions immediately.

Clinicians recommend that if you are on a long term protocol, blood tests for liver function should take place every three to six months. You can usually arrange these through your GP or within clinic if this service is available. Your GP should notify you if there are result abnormalities and your specialist can advise on whether to decrease or stop antibiotics as a result.

We explain the importance of healthy gut bacteria.

Read Also: Is It Ok To Take Probiotics With Antibiotics

Antibiotics And Persister Cells

One of the key issues in the treatment of a chronic UTI is the known problem of persister cells. These are infected bacterial cells which lie dormant deep within the bladder wall. Whilst the antibiotic options covered above will target those bacterial cells which are either actively dividing on the wall of the bladder, are newly introduced into the bladder via the urethra or have been shed into the urine by the immune system response, ongoing treatment options must take into account the problem of persister cells.

Flares often occur when dormant bacteria are stimulated, break out of their own cells and seek new cells to colonise. The immune system reacts accordingly causing an increase in symptoms. It is critical that ongoing antibiotic coverage is available during these periods. Discuss with your chronic UTI specialist the most appropriate management options to suit you.

Michael Hsieh Md Urology Washington Dc Usa

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Michael Hsieh, MD, PhD, is the Director of Transitional Urology at Childrens National Health System and the George Washington University.

Dr. Hsieh has extensive experience in laparoscopic and robotic surgery for urologic conditions, but also runs an NIH-funded bladder biology research group.

Throughout his research, Dr. Hsieh has studied the naturally occurring microbiome, and how the presence of non-pathogenic bacteria may prevent urinary tract infections. He also headed a research group focussed on bladder inflammation, UTI and bladder cancer.

Most patients that see Dr. Hsieh for urinary tract infections have suffered from multiple episodes and are desperate for something that works. His investigative approach has enabled him to assist patients with previously unidentified urinary pathogens.

I am very careful about labelling patients with IC, I think a lot have occult UTI with difficult to culture organisms. By utilizing more accurate testing methods we are able to identify pathogens in many cases, and develop appropriate treatment.

Dr. Hsieh takes a multi-pronged approach to diagnosing, treating, and preventing UTIs. In order to reach a diagnosis, he supplements conventional urine testing with microbiome-based techniques that are highly sensitive and can detect UTI-causing bacteria that dont always grow out using conventional urine culture methods.

Learn more about Dr. Hsiehs approach to recurrent UTI treatment.

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Alternative Therapeutic Options To Antibiotics For The Treatment Of Urinary Tract Infections

  • 1VBMI, INSERM U1047, Université de Montpellier, Service des Maladies Infectieuses et Tropicales, CHU Nîmes, Nîmes, France
  • 2VBMI, INSERM U1047, Université de Montpellier, Service de Microbiologie et Hygiène Hospitalière, CHU Nîmes, Nîmes, France
  • 3Service des Maladies Infectieuses, AP-HP Raymond-Poincaré, Garches, France
  • 4PRES Centre Val de Loire, Université François Rabelais de Tours, Tours, France
  • 5Service des Maladies Infectieuses, CHU Tours, Tours, France
  • 6Service dUrologie, CHU Tours, Tours, France

Chronic Urinary Tract Infection

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What is a chronic urinary tract infection?

Chronic urinary tract infections are infections of the urinary tract that either dont respond to treatment or keep recurring. They may either continue to affect your urinary tract despite getting the right treatment, or they may recur after treatment.

Your urinary tract is the pathway that makes up your urinary system. It includes the following:

  • Your kidneys filter your blood and generate body waste in the form of urine.
  • Your ureters are tubes that carry urine from the kidneys to the bladder.
  • Your bladder collects and stores urine.
  • Your urethra is the tube that carries urine from the bladder to the outside of your body.

A UTI can affect any part of your urinary system. When an infection only affects your bladder, its usually a minor illness that can be easily treated. However, if it spreads to your kidneys, you may suffer from serious health consequences, and may even need to be hospitalized.

Although UTIs can happen to anyone at any age, theyre more prevalent in women. In fact, the

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Can Uti Treatment Succeed If Biofilms Are Involved

Biofilms that cause chronic urinary tract infections can be difficult to detect and very hard to treat efficiently. Currently, no guidelines exist to help clinicians and microbiologists detect and treat biofilm infections of the urinary bladder.

Most UTI guidelines are aimed at management of simple uncomplicated UTI. It can be very difficult to successfully manage complex or recurrent UTI in primary care. If symptoms persist, or where there is diagnostic uncertainty GPs will need to make a referral for specialist assessment.”

Free-floating bacteria behave very differently to bacteria within a biofilm. Bacteria growing as biofilms are also much more difficult to identify in a urine sample.

No three or five day course of antibiotics designed to treat free-floating bacteria is even going to make a dent on your average biofilm.

As much as we do know about biofilms, the mechanisms behind this phenomenon are still poorly understood. To add another layer of doom, biofilms can be formed by one or multiple species, in complex structures.

If the right treatment is found for one of the species in a biofilm, as its prominence decreases, a second species may rise to take its place.

This doesnt necessarily mean treatment is impossible, but it can take a few rounds of different targeted antibiotics to get to the bottom of a multiple-bacteria biofilm. Learn more in our dedicated section on chronic UTI and biofilm.

What Is The Scope Of The Problems Surrounding Recurrent Utis

Long Term Chronic UTI Treatment: Chronic UTI Treatment, with Dr. Stewart Bundrick, Part 2

We have all come to understand that recurrent urinary tract infection in women is a major health care problem. Depending on what literature you read, between 40% and 60% of women suffer from urinary tract infection sometime in their lifetime. Many of these women have recurrences, and these recurrences can occur within 6 months in about 20% of patients who have an incidental urinary tract infection. One in 5 women overall suffer recurrent urinary tract infections that is defined as greater or equal to 3 UTIs per year. However, many of these women suffer much more, with the average being 6 UTIs per year in this population of women with recurrent urinary tract infection. To summarize, in the course of any year, 11% of women will suffer a urinary tract infection while 3 out of 100 will suffer from recurrent urinary tract infections. So, this really is a major health care issue.

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What Is The Long

Urinary tract infections are uncomfortable and painful. Most chronic UTIs will resolve with a prolonged course of antibiotics, but monitoring for further symptoms is important since the chronic UTIs usually recur. People with UTIs should monitor their bodies and seek immediate treatment with the onset of a new infection. Early treatment of infection decreases your risk for more serious, long-term complications.

If youre susceptible to recurring UTIs, make sure to:

  • urinate as often as needed
  • wipe front to back after urinating

How Long Do I Need To Take Antibiotics To Treat A Uti

How long you take antibiotics for a UTI depends on how severe your UTI is and which antibiotic youre prescribed. Some medications like fosfomycin only require one dose, while a more severe UTI might require 14 days or more of treatment. Most require 3 to 7 days of treatment.

Within the first 1 to 2 days of starting your antibiotics, youll probably notice your UTI symptoms start to fade away. If your UTI is more severe or youve had symptoms for a while before starting antibiotics, it might take a few more days for you to notice improvement.

In any case, its important to take all the antibiotics youre prescribed, even if you start feeling better before finishing them. Stopping antibiotics early can lead to antibiotic resistance, which means the medication might not work as well as it should if you need it to treat an infection in the future. It can also mean your UTI might come back if you havent treated it completely.

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Hunners Ulcers Harbor Bacteria

Melissa We do have some other questions about long-term antibiotics but I wanted to go back briefly to the infection embedded in the bladder wall. I wanted to ask if that is what you believe is the cause for the ulcers that are sometimes referred to as Hunners lesions, and if so, can those then be treated in the same way?

Ruth: Well Hunners ulcers remind me of stomach ulcers. In the stomach you have H. pylori as a causative agent. It gets embedded in the lining and if it goes for a long time untreated the lining ulcerates. I think its the same process in the bladder wall.

Hunners ulcers are infection and I have had several patients that we have successfully healed by treating the bacteria that are responsible for damaging the bladder wall in that location to that extent.

Now some people have procedures in which they go in with a laser and they actually treat that area and that resolves a lot of the pain issues a whole lot faster. So that is an option but I think thats only a temporary solution because if theres still a lot of infection throughout the bladder wall, the propensity is going to be to form more ulcers down the road if you fail to treat the infections that are responsible in the first place.

How Do Antibiotics Treat A Uti

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UTIs can be caused by many different types of germs including bacteria or fungi and in rare cases, even viruses. But bacterial UTIs are the most common.

If you have a bacterial UTI, the only way to treat it is by getting rid of the bacteria thats causing it. Thats where antibiotics come in. They either stop those bacteria from growing or directly kill the bacteria altogether.

Its worth noting that antibiotics only treat UTIs and other infections caused by bacteria. If you have a fungal or viral UTI, antibiotics wont help.

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Should You Try Uti Home Remedies

The only person that can make this decision is you. And before deciding, you should learn what you can about any UTI remedy youre considering.

An its important to understand this:

The absence of evidence around non-antibiotic UTI treatments does not mean they do not work, but it does mean we dont know if they work.

Just because a number of people agree in a UTI forum that a particular remedy works for them, it does not mean it will work for you, or that it even works at all.

Think about it If you rely on a specific home remedy every time symptoms of a UTI flare up, yet you continue to get UTIs, you can almost guarantee that remedy is not addressing the underlying problem.

Obviously, this does little to curb the enthusiasm for natural UTI remedies online. There is always plenty of discussion on how to treat your next UTI, but very little around resolving the issue so it never happens again.

Its essential to separate the myths from fact there are natural UTI remedies that are looking very promising as future UTI treatment options, but there are other very well publicized natural UTI remedies that have been proven ineffective.

It can be difficult to figure out who to believe. So in our UTI home remedies article weve taken a look at how home remedies stack up, including D-mannose and vitamin C.

Ruth Kriz Video 3 Transcript: Antibiotic Bladder Instillations And Other Chronic Uti Treatment Methods

Melissa Now that weve talked about antibiotic resistance maybe you can tell us a little bit more about your general approach to treatment for chronic infection.

Ruth: A while back I mentioned that things have causes and if you dont address the root cause and eliminate it then you will never get rid of the problem. And so when we have bacteria that are not just free floating in the urine, theyre not just attached to the bladder wall, they have invaded the bladder wall.

If theyre in the interstitial spaces, which is the space between the cells, thats bathed with lymphatic fluid and I have seen pathology slides of bladder wall biopsies in which you can see the bacteria, so we know it gets there. When its in the interstitial spaces it causes swelling, inflammation, pressure on the nerves and pain. And thats where the definition interstitial cystitis came from, was the inflammation in those interstitial spaces.

When you see that, you have a lot of work to do. We have to diminish the infectious load sufficiently that the bladder wall can do its repair job. It takes about four month months for damaged bladder wall tissue to regenerate after youve reduced the infectious load sufficiently that it can seriously start the healing and repair process.

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Causative Factors And Pathogenesis

Escherichia coli is the predominant uropathogen isolated in acute community-acquired uncomplicated UTIs, followed by Staphylococcus saprophyticus . Enterococcus, Klebsiella, Enterobacter, and Proteus species are less common causes.7

In recurrent uncomplicated UTIs, reinfection occurs when the initially infecting bacteria persist in the fecal flora after elimination from the urinary tract, subsequently recolonizing the introitus and bladder.1 A number of host factors appear to predispose otherwise healthy young women to recurrent UTIs. These include local pH and cervicovaginal antibody changes in the vagina greater adherence of uropathogenic bacteria to the uroepithelium and possibly pelvic anatomic differences, such as shorter urethra-to-anus distance.

Diabetes mellitus, neurologic conditions, chronic institutional residence, and chronic indwelling urinary catheterization are important predisposing factors for complicated UTIs. In affected patients, organisms that are typically less virulent may cause marked illness, although E. coli infection remains the most common organism in nearly all patient groups. Klebsiella and group B streptococcus infections are relatively more common in patients with diabetes, and Pseudomonas infections are relatively more common in patients with chronic catheterization. Proteus mirabilis i s a c ommon u ropathogen i n p atients with indwelling catheters, spinal cord injuries, or structural abnormalities of the urinary tract.7

Conservative Approach To Prevention

What to Do When a Relapse Occurs: Chronic UTI Treatment, with Dr. Stewart Bundrick, Part 3

A number of risk factors, other than sexual activity, have been identified in patients with recurrent UTIs. Contraceptive methods employing a diaphragm and/or spermicides and tampon use have been associated with increased risk of UTI., Contraceptive methods should be changed, spermicidal agents should be discontinued, and patients should consider using pads instead of tampons. Drinking cranberry juice or cranberry extract appears to be a safe and possibly effective method of reducing the frequency of recurrent UTIs in some women. Attempting to change the vaginal flora by douching with lactobacilli has been suggested but not proven. It is probable that in the future, some form of immunization program will be the key to prevention of recurrent UTIs. It is probably appropriate to suggest that patients stay hydrated, void regularly, avoid feminine hygiene products such as vaginal douches and scented bubble baths, and practice proper toilet habits , although none of these practices has proven to be effective in reducing the incidence of recurrent UTIs.

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