Question: Dr Tayal:

I am posting this as a new question
I am posting this as a new inquiry
As you recall..

About two weeks ago my mother had mild bladder symptoms.
She had positive for nitrites/leukocytes
Her symptoms resided as the week went on but her rbcs were 200 more and pink tinge to urine in toilet bowl.
A lab culture showed ecoli sensitive to fosfomycin.
She was given this past Sunday and her 15mg xarelto was stopped.
Within three days or this past Wednesday, she was negative for rbcs, wbcs and nitrites.
She resumed xarelto Wednesday evg and the preventative 2000mg mannose.
As of this morning, her urinalysis was negative for rbcs but positive for nitrites and leukcocytes - she has obvious symptoms other than a bit of abdominal pressure
is how the 1st episode started

How do you handle this?

No obvious symptoms than a bit of abdominal pressure.

This is exactly how the first episode started

The uro clinic ignored my mother this week.
I went to see the family doctor - he prescribed nitro for 10 days.
A new urine sample was sent off.
Two urinalysis tests were taken today - both positive for nitrites/leuko
but negative for rbcs
As you may recall - that was the whole reason behind this past Sunday
why fosfomycin was given and xarelto stopped.

My mother has had in the past - ecoli treated with an antibiotic lets say 10 days nitro - and 14 days later shows re-immerging symtoms and new urine culture still shows ecoli sensitive to original antibiotic.

Another online source implied today, this is just the remnants of the 1st episode
and not necessarily a new infection.
She has no signs yet and no RBCS
She seemed fairly chipper this evg and even went 10 minutes on a treadmill.
But Unfortunately, I dont think this will disappear.
Mannose did a wonderful job for 8months and perhaps its keeping it at bay but I dont think it will clear it. Anyhow, thanks for listening.
Canada healthcare is very primitive especially for XXXXXXX care

So I havent given the nitro yet.....as I know each round of antibiotics especially in close succesion will make it more difficult in the future.
The fosfomycin should have worked.

I have uploaded the 2nd urine sample yesterday

Is the nitrites/leukocytes - vaginal contamination

But I had two similiar urinalysis strips yesterday

Neg - RBCS
Positive- Nitrites/Leukocytes

The toilet water this morning still had no pink as was the case about a week ago

Thankyou

I saw my mothers family doctor this past Friday before the holidays.
He prescribed nitrofuran for 10 days based on the previous culture.

The second culture results will be fully known today and I havent given her anything.

She is symptom free but nitrites/leukocytes still present.
It appears based on the strips we are on the cusp between negative and the lowest level of blood.

Why the fosfomycin failed though the ecoli was sensitive?

But bottom line and after 20 utis in the last 5 years - the past two weeks
were episodes where there were no discomfort symtoms only the aspect
of high RBCs (pink tinge urine).

For that reason alone and antibiotic must be given -correct?

The probability this will resolve on its own is minimum?

I am hoping if she can clear this ecoli - she can go back on the full mannose preventative regiment which kept her symptom/blood free for 8 months.

However, I know from historical experience - successive rounds of antibiotics leads to new repeat episodes shortly after stopping.

Its that what I wanted to avoid last last before giving the fosfomycin and now again with the nitro at hand

Guess you were correct again.

My mother had blood in the urine again this afternoon.
Urine culture still not in but gave her fosfomycin and will cease the xarelto again.

So this appears then the new norm - no obvious bladder discomfort but bloodloss

Usually when my mother had a symptomatic ecoli, the antibiotic was given immediately than wait a few days, this was not the case with the 1st episode with the fosfomycin. Whether that had a siginficant influence.

I imagine the fosfomycin will prove to be sensitive still

Gave her the nitro this afternoon - not fosfomycin

As of this morning the nitrites are negative but the urine sample container is coca coloured. This is the most tinged I have seen it in the last 2 weeks.
She stopped the xarelto last night and is in 10 days nitro.

Urine culture is still not in. I regret now not giving my mother the nitro much earlier.

I hope she is on the mend again.

One shouldnt be online trying to solve this type of issue

I dont expect an immediate response.
My mothers condition has improved.
I have also consulted with a couple of XXXXXXX based uros.

They mentioned nitrofuran to eliminate an infection
-given 20 days instead of 7 to 10 days
-urine alkalzer be given
-North XXXXXXX sources imply a lower ph to be effective
-Nitro is an antiseptic vs antibiotic

I want her to clear this ecoli properly so hopefully the 2000mg mannose can be used again. ..but its all trial and error.
I believe the hemuratia affected the fosfomycin efficacy

The second culture was a carbon copy of Dec 13th - high ecoli with same sensitivities