Suggest Treatment For UTI In An Elderly Person

Question : Looking for only Dr P.T. XXXXXXX to answer as a followup for a bladder uti in a XXXXXXX - 90 - thanks

Dr P

I was the chap from yesterday with a XXXXXXX mother asymptomatic ecoli episode but with bleeding eventually. They didnt allow any more posts on the previous question.

I checked my mothers urine this evg again.
Its the same as it was this morning - no rbcs but positive leukocytes/nitrites.

The urine culture will be available tomorrow and imagine it will be some ecoli count
in lieu of vaginal contamination.

It follows the same pattern as over a week back
She had no symptoms but about 5 days in - the RBCs arose.

I have attached a crotian study on the use of mannose
2grams for 6months.

She was on that for 6 months, then I tapered down to 1500mg
and this most recent episode arose BUT no discomfort symptoms other than the bloodloss.

I realize you inferred nothing wrong with nitro. However in the past - she would be on it for 10 days and after 2 days symptoms reappeared -the subsequent culture would still show a sensitive ecoli to nitro.

Young women are supposed to take >10grams mannose with alot of water intake
to flush out ecoli once an active infection. That not going to happen.
I am lucky that my mother may drink 1.5litres daily vs the normal 1L

Anyhow I shall provide more info tomorrow.

http://link XXXXXXX com/article/10.1007/s00345-013-1091-6

Dr XXXXXXX

The urine culture still has not come in.
My mother started to show rbcs in her urine today.
I have given her the first nitro capsule.

I imagine ecoli will be identified in the 2nd culture.

I was highly hoping of the many symptomatic bladder episodes in the last 5 years
-this was one of the first symptom free ones OTHER than high rbcs and eventually noticable pink urine tinge.
They do not advocate treating asymptomatic seniors in Canada
so thus I held off 5days in after the 1st episode and eventually fosfomycin was
given.
Now with the second episode - everything appeared negative on Thursday
but by Friday, positive nitrites/leukocytes.
You had stated "remnants". It doesnt appear to be the case.

I presume the nitro will hopefully clear this 2nd episode or lingering 1st one.
And imagine the 2nd culture will still show sensitivity to fosfomycin.

Is then this correct - even if absence of obvious discomfort symptoms BUT if blood is present - an antibiotic will need to be given with stoppage of xarelto

Is this the new norm?

Why did you also state 20 days of nitro than 10 days what this lovely nation has as standard PLUs the purpose of a neutralizer. Mothers urine is 5

Because it being a holiday and this is sloppy Canada - the lab culture still isnt in.

Since my mother had the pink tinge in her urine yesterday evg - the nitro was begun yesterday already with xarelto ceased.

Nitrites and Leukocytes were positive for the last 3 days after it had been negative
for 2 days. I was not going to chance it any more. The family doctor who prescribed the nitro - advised to to take it on Friday and I held off another two days and she developed blood again.

I shall post the urine culture when it becomes available

The second sample or urine culture taken this past Friday was the same carbon copy of results as Dec 13th - high ecoli with same sensitivities.

That second culture was taken 5 days after the fosfomycin XXXXXXX was originally taken. Something went wrong here. It was stored for 8months under proper temperatures and expiry was still a good year.

It has been taken on 3 different occasions within a day of symptoms and was successful.

The nitro appears to be working but now we begin another period of uncertainty

No, I dont doubt that ecoli is still in my mothers urinary system.
I imagine while she is on the nitro - her urine culture will be negative.

I still find stock hopefully the mannose will prevent future occurrence once she clears this episode thoroughly.

As mentioned, she had a March ecoli uti (no mannose) symptoms - took nitro for 10 days - a few days later, her symptoms returned for yet another nitro sensitive ecoli. She was put on cipro (500mg twice a day for 5 days). She immediately went on 2000mg mannose therafter and was 8 months symptom free. Regular urinalysis tests showed negative rbcs and nitrites.
XXXXXXX uses 20 days for some rationale I imagine - North XXXXXXX doesnt
You also stated urine akalizer? My mothers urine is pH 5

My mother was 2.5 years on nitro with eventual elevated liver enzymes
as a preventative. ALT - 150's vs in 20's. It dropped within a month.

So there is has to be some bridge between this episode to head back to the mannose

Questions

1. What is the rationale of 20 days for nitro and what amount is that daily
2. Wny the urine alkalyzer?
3. Based on what I have described, I doubt my mother willl ever be
asymptomatic colonized with ecoli with no symptom - ie bloodloss) - correct?
4. Can a 1 dose antibiotic vs several doses spread over many days have
a failure response because of hematuria?
5. Is 50mg nitro daily as a preventative be risking a surgence of the ecoli
eventually - she is a 200lb woman
6. Mother has intestinal diverticula - would bladder diverticula create
the situation of standard antibiotic regiment to fail.
She had a few abdominal ultrasounds but never a cystogram - she doesnt
want it

Anyhow, thanks for your inisight. You have provided some good information overall. However the aspect of the nitrite/leukocyte remnants held not much water. Nitrites means an active ecoli population