Advice on UTI treatment

[randymarsh]

Had a UTI last year with blood in urine.  Had ultrasound and cystoscopy to rule out anything serious.  

 

My symptoms keep coming back despite courses of antibiotics.  I hear it's common in men as difficult to kill off the bacteria completely.

 

My last successful treatment was taking a long course of cephalexin (about 12 days I think) which left me with no symptoms for 3 or 4 months.  However, the last 3 weeks I've had symptoms again (feeling like i need to urinate a lot, very mild discomfort in bladder area).  I tried cephalexin again but after a week it had made no difference so I stopped.  

 

I've had recent urine analysis and no bacteria or blood cells were detected.  So I'm in this difficult position again where I know I'm not ok but the tests are telling me I am.  

 

Does anyone know the best antibiotics to kill this off for good?  I've read rocephin can work but it has to be injected daily and I'm not sure on the length of treatment.  

 

And yes, before anyone tells me, I will discuss again with a urologist but this thread is just to help me learn more in advance.  

[randymarsh]

Just had urine test done and a few WBC came back  (1-2).  Going to try doxycycline.  

[Here2008]

If you are male and over 40 this could be Prostate related. Time to consult a urologist. Just "trying" random antibiotics is probably not a good idea especially if  a urinalysis fails to demonstrate an infection.

[randymarsh]

Thanks.  The ultrasound I had showed no prostate issues.  All signs point to a UTI caused by bacteria.

 

The problem I'm having is getting anyone to pinpoint the bacteria and therefore, exactly which antibiotic i should be taking.  

 

First time I had UTI was last year back in UK and they did urine analysis which showed red blood, white blood, and bacteria.  But they don't ever tell you what bacteria it is.  They give a 'best guess' treatment, in the UK this is Augmentin.. this is when I was in A&E because it was bad.  They gave me Augmentin IV and then remainder as pills for 7 days.  He said it is effective in 90% of cases, so they always give it.  The augmentin made me feel a lot better pretty much as soon as I started the IV but clearly it never completely cleared my infection.

 

Next time UTI came back, I saw probably the best urologist in Chiang Mai (and probably one of the best in Thailand) and he gave me cephalexin.  Again, without actually testing the bacteria.  Only the same urine analysis on RBC, WBC etc.  So again, this was a 'best guess' treatment.  And again, it worked for a while.

 

And now today, hospital in Pattaya.  Same urine analysis... same results high WBC.  But no pinpointing of the cause/bacteria, and another best guess - doxycycline.

 

Sheryl - or anyone else - is it actually possible for them to do a more detailed urine culture to identify the specific bacteria?  No one ever seems to offer me this.  The urine tests I get done are pretty much immediate - get the results back in 20 minutes.  Is there a urine culture I can ask for where they let bacteria grow over a number of days, similar to throat swabs?  I think this is what I need at this point... if the doxycycline doesn't work.

 

 

Edited August 6, 2017 by randymarsh

[Here2008]

1 minute ago, randymarsh said:

is it actually possible for them to do a more detailed urine culture to identify the specific bacteria?

Yes -------------------

[kkerry]

You can get a culture done but no guarantee it will provide you with an answer, which I was told beforehand might be the case. Fortunately after several tries the anti-biotics kicked in and I haven't had any problems since despite never knowing what caused the problem in the first place. Initial followup tests were saying I should be okay but I wasn't, felt like what you describe. Might have been doxy that killed it for good, can't recall now. 

[tonray]

I think I remember that you were seeing actual red colored blood after exercise in your urine. This is a bit different than a urinalysis that finds a few red blood cells. I think you need to find a good urologist (or maybe try a different one) to really get to the source of this problem. Visible blood in urine is something fairly odd for a man. You had said you had an ultrasound of the prostate, was PSA level checked, and also blood test for kidney function to see if anything is amiss there ? A scope into the urethra to inspect the bladder might also be something that should be done if not already.

Edited August 7, 2017 by tonray

[Sheryl]

9 hours ago, randymarsh said:

 

Sheryl - or anyone else - is it actually possible for them to do a more detailed urine culture to identify the specific bacteria?  No one ever seems to offer me this.  The urine tests I get done are pretty much immediate - get the results back in 20 minutes.  Is there a urine culture I can ask for where they let bacteria grow over a number of days, similar to throat swabs?  I think this is what I need at this point... if the doxycycline doesn't work.

Yes and that is exactly what you need, assuming you have already  tested negative for chlamydia and gonorrhea  (if not then that should be the first step). 

 

Not just a culture, but a culture and sensitivity to find out what antibiotics the bug is sensitive to. As you have already taken antibiotics it is quite possible it has developed resistance. Self-prescribing additional meds may just worsen matters.

 

Insist on a culture and sensitivity and if necessary, change doctors.  A good urologist would already have done this IMO.

 

 

 

 

 

[xylophone]

On 8/7/2017 at 8:34 AM, Sheryl said:

Yes and that is exactly what you need, assuming you have already  tested negative for chlamydia and gonorrhea  (if not then that should be the first step). 

 

Not just a culture, but a culture and sensitivity to find out what antibiotics the bug is sensitive to. As you have already taken antibiotics it is quite possible it has developed resistance. Self-prescribing additional meds may just worsen matters.

 

Insist on a culture and sensitivity and if necessary, change doctors.  A good urologist would already have done this IMO.

 

 

 

 

 

You should absolutely insist on this and do not be fobbed off with anything else.

 

I had a similar thing to you ongoing for six months, perhaps almost a year if I think back, and every time I asked for a culture it was never done.

 

Eventually I became very sick and was admitted to hospital and then they did a culture and sensitivity test and it turned out I had E. coli ESBL, which is just about resistant to the most widely used and common antibiotics and there were only four antibiotics which it was sensitive to, unfortunately all of these had to be administered intravenously.

 

The first one started to damage my kidneys, which the specialist had said could happen, so onto the second one and this entailed about 90 minutes in a hospital room with an intravenous application of the antibiotic, this for two weeks.

 

Final tests showed that it had been eliminated, for which I was very thankful.

 

One of the urologists at Bangkok Phuket Hospital actually ordered me out of his office because the levofloxacin he was giving me wasn't working and was causing muscle pain, so I said I wasn't keen on taking it any more. He then said in that case there was nothing else he could do for me and I should leave and I believe this contributed to my condition quite markedly as he had already tried quite a few others without any culturing whatsoever.

 

Hopefully they can find something for you, on the other hand there is something else you may wish to consider............. prostatitis can give all of the symptoms that you have described and there are basically two types, bacterial and nonbacterial. You would think that the bacterial one would be easily eradicated with antibiotics, but it isn't always that simple because most of the antibiotics find it very difficult to penetrate the prostate, so often long courses are needed if that is the case.

 

Nonbacterial prostatitis however is a different matter and because they don't know what causes it, it is very difficult to treat and many of us who have suffered from it for decades have tried everything, mostly to no avail. Strangely enough doxycycline does have an effect, mainly because it is fairly good at penetrating the prostate and secondly because it has some anti-inflammatory properties and that's why quite a few of the specialists I saw recommended it.

 

That is just for information, however take Sheryl's advice and INSIST on a culture and sensitivity test.

 

Good luck.

[randymarsh]

Thanks for responses everyone.

 

Just about to finish my 7th day on doxycycline and my symptoms have cleared up - took a while though, i'd say from day 5 onwards have felt back to normal. 

 

I've been taking 2x100mg a day.  Should I stop now?  I'm wondering whether to keep going and do a 10 day course, or even longer?  The only thing is I've been having some side effects.  Do you think cutting back to 100mg a day for another 3 days would be worthwhile?  

 

Dose info on internet suggests 100mg is a standard maintenance dose...

 

 

ORAL:
Most Products:
-Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
-Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
---More severe infections (especially chronic urinary tract infections): 100 mg orally every 12 hours

[xylophone]

1 hour ago, randymarsh said:

Thanks for responses everyone.

 

Just about to finish my 7th day on doxycycline and my symptoms have cleared up - took a while though, i'd say from day 5 onwards have felt back to normal. 

 

I've been taking 2x100mg a day.  Should I stop now?  I'm wondering whether to keep going and do a 10 day course, or even longer?  The only thing is I've been having some side effects.  Do you think cutting back to 100mg a day for another 3 days would be worthwhile?  

 

Dose info on internet suggests 100mg is a standard maintenance dose...

 

 

ORAL:
Most Products:
-Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
-Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
---More severe infections (especially chronic urinary tract infections): 100 mg orally every 12 hours

Did you have a culture done?? MOST IMPORTANT.

 

Take the full dose and full course of doxy then you can drop to the 100 mg per day regimen and see how you go, but why no culture and sensitivity test done?????????????

[randymarsh]

I think the doxy has killed it to be honest.  If i did a urine test now (the 20 minute one), they wouldnt find any bacteria / wbcs.  

 

I'm hoping I'm good now but if it comes back then yes I'll definitely get the culture.