Columns The MS Wire - A Column by Ed Tobias Urinary Tract Infections Are Getting Harder to Treat Urinary Tract Infections Are Getting Harder to Treat by Ed Tobias | July 23, 2019 Share this article: Share article via email Copy article link Urinary tract infections (UTIs) are a problem for a significant number of people with multiple sclerosis (MS). As many as three in 10 may wind up needing treatment for one. So, I was concerned when I read a New York Times article reporting that UTIs are becoming harder and harder to treat. The problem is that antibiotics don’t work as well as they once did. In New York City, one-third of the most common UTIs are resistant to the widely used antibiotic Bactrim (sulfamethoxazole/trimethoprim), and one-fifth of the infections are resistant to five other commonly prescribed treatments. According to The New York Times, “ampicillin, once a mainstay for treating the infections, has been abandoned as a gold standard because multiple strains of U.T.I.s are resistant to it. Some urinary tract infections now require treatment with heavy-duty intravenous antibiotics.” The city’s health department calls antimicrobial resistance an “urgent public health threat.” It considers the UTI problem to be so serious that it’s encouraging doctors to use a new smartphone app that contains data on the various UTI strains and the most effective antibiotics to help inform prescribing choices. The newspaper looked at the case of a woman who took Bactrim and nitrofurantoin as treatments for her UTI. “Her doctor prescribed a third drug, ciprofloxacin, the last of the three major front-line medicines, and cultured her urine. The culture showed her infection was susceptible to the new drug, but not the other two,” the Times noted. Interestingly, when I developed a UTI a couple of years ago, my primary care physician prescribed Cipro (ciprofloxacin) right away. It knocked it right out. UK treatment guidelines In the U.K., researchers report that more than one-third of laboratory-confirmed UTI cases caused by E. coli — the most common cause of UTIs — are now resistant to key antibiotics. In an attempt to improve the situation, the U.K’s National Institute for Health and Care Excellence (NICE) issued proposed guidelines for a “prescribing strategy” for some patients with lower UTIs, aiming “to optimise antibiotic use and reduce antibiotic resistance.” NICE recommends that doctors start by advising women patients who are not pregnant to manage their symptoms with self-care, if possible. If the symptoms don’t improve, nitrofurantoin is one of two first-choice antibiotics recommended — but it’s also one of the two medications that failed to work for the woman mentioned in The New York Times article. For pregnant women and men, a more rapid treatment start is recommended. It’s a difficult balance Rush to treat or wait? Use an antibiotic or not? It’s a tough decision. I’m glad that my doctor ordered Cipro for my UTI right away because it was fast and efficient. But it was another use of an antibiotic at a time when scientists are recommending more judicious use of the treatment worldwide. Perhaps you might want to discuss treatment options with your doctors before you contract a UTI and also ask them about preventive measures that you can take. You’re invited to visit my personal blog at www.themswire.com. *** Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to multiple sclerosis. Print This Page About the Author Ed Tobias People say to write what you know and Ed Tobias knows about MS. He's lived with the illness since 1980, when he was 32 years old. Ed's a retired, award-winning broadcast journalist and his column combines his four decades of MS experiences with news and comments about the latest in the MS community. In addition to writing his column, Ed is one of the patient moderators on the MS News Today Facebook, Twitter, and Instagram sites. He’s also the author of “The Multiple Sclerosis Toolbox: Hints and Tips for Living with M.S.” Ed and his wife split their time between the Washington, D.C. suburbs and Florida’s Gulf Coast, trying to follow the sun. Tags urinary tract infection (UTI) Comments Frank Campo If there's no money in it drug companies will ignore it. Reply Sarah Antibiotic resistance is a huge issue, of course I agree. But Cipro right away as a front line med is dangerous because of the prevalence of developing C. Diff. Please be careful. Reply Ed Tobias You're right, Sarah. That's the problem. Ed Reply Julie Farkas It takes 3 days for a urine culture. If the culture process could be one day or less, women, (and doctors) would be willing to wait before prescribing. "Self-help" at home is painful, and doesn't work for most people which is why it is not recommended for pregnant women. I hope the root problem, a three day delay in urine cultures, will be disclosed to patients. Maybe a patient will have an idea on how to speed it up! Reply Ed Tobias Julie, The Times article agrees with you. "But more immediately, a partial solution would be the development of quick, cheap diagnostic tools that would allow an instant urine culture so that a doctor could prescribe the right drug for U.T.I.s." But it fails to give any indication that anyone is currently developing an instant culture. I'll bet someone could get rich inventing one. Ed Reply Caroline Borduin So I have a UTI right now which is resistant to many antibiotics. Due to odd circumstances (I was first diagnosed on cruise ship without culturing facilities) I have been on 5 antibiotics. Back on land and now waiting for my second culture as the third antibiotic (which a culture showed infection was sensitive to) didn't seem to beat it. Having been in hospital twice with UTIs that turned into septicemia, I'm super nervous about this. I'd love an article with copious details about how to prevent UTIs. More than the standard tips. Also, why are people with MS so susceptible to them? Reply Ed Tobias Hi Caroline, I'm sorry to hear of your UTI problems. I'll try to research UTI prevention and see if I can come up with anything better than "standard tips." If I can, I'll write another column on the subject. Ed Reply Julie Farkas If you are on an immunosuppressant DMT for MS, you are more likely to get all sorts of infections, including UTIs. It's a price you patients pay for an effective treatment to MS. Reply Suz Sensitivity testing with culture should be manadtory. Reply Claudia Chamberlain Did I miss something? I get why pregnant woman are treated right away with the good stuff, but why men? So us older ladies have to "self treat" with what? Cranberry juice? Not clear. Glad I don't live in the UK... Reply Ed Tobias Hi Claudia, I've read the supporting information on the NICE website several times and, for the life of me, I also can't figure out why it's recommended that men receive immediate treatment. Incidentally, the NICE report also says that, in their opinion, cranberry juice isn't effective. Go figure. Ed Reply patricia williams An older Doctor when I was hospitalized for a uti told me to drink cranberry juice everyday. Its been 3 years since I have ad a uti. Reply Jumpy Before taking Cipro you need to read the full page warning sheet that comes with it. Cipro is bad for Osteoarthritis or any one with torn muscles. Even can cause damage months later! It can cause muscle to bone detachment. I had 2 torn muscles in my shoulder and I was given it twice before I wondered why the bottle said DO NOT TAKE WITH Dairy or Calcium and Mineral supplements. It could cause a detached or tear months after treatment even in some one with no previous problem. I have a previous post in a recent UTI collum her with more info on UTI. Reply Ed Tobias Thanks for that information, Jumpy. I would hope that any physician prescribing Cipro, or any other medication, would advise the patient of the med's contraindications. But I know that most don't. That's why we all need to look out for ourselves and, as you point out, read the label. Ed Reply Tazz And in Dec 2018 the FDA issued a new alert about an extremely rare but potentially fatal impact from Cipro - aortic aneurysms and dissections. Their review found "that fluoroquinolone antibiotics can increase the occurrence of rare but serious events of ruptures or tears in the main artery of the body, called the aorta. These tears, called aortic dissections, or ruptures of an aortic aneurysm can lead to dangerous bleeding or even death. They can occur with fluoroquinolones for systemic use given by mouth or through an injection." Their recommendation is that doctors "should avoid prescribing fluoroquinolone antibiotics to patients who have an aortic aneurysm or are at risk for an aortic aneurysm, such as patients with peripheral atherosclerotic vascular diseases, hypertension, certain genetic conditions such as Marfan syndrome and Ehlers-Danlos syndrome, and elderly patients." Their warning states that "background risk has been estimated from nine aortic aneurysm events per 100,000 people per year in the general population to 300 aortic aneurysm events per 100,000 people per year in individuals at highest risk. Because multiple studies showed higher rates of about twice the risk of aortic aneurysm rupture and dissection in those taking fluoroquinolones, FDA determined the warnings were warranted to alert health care professionals and patients." I had never been on Cipro and do not have any connective tissue disorders such as Marfans, CREST etc, but I had an idiopathic and nearly fatal aortic dissection and I'm not the same person I was. It's scary stuff - as eight months after surviving the dissection I was in hospital with a UTI, and they gave me Cipro - although the warning hadn't been issued back then. Reply Ed Tobias Thanks for the info, Tazz. I removed your link because of our security procedures, but I think you got it all the relevant info into the post anyway. Ed Reply LINDA Fitch I am one of the unfortunate MS sufferers who get UTIs often and predictably. Along with them comes incontenence making it impossible for me to leave home. Self cathIng has helped some but in situations where I must travel and am not in control of my bathroom breaks, or being in a wet bathing suit, or sweating a great deal or sex almost always leads to an infection unless I take preventative antibiotic, or I begin taking an antibiotic at the first sign of burning. My neurologist has agreed with this but my new urologist disagrees and wants me to wait until I get a full blown infection, bring in a sample to be tested. I only agreed to go to a urologist because I was hoping I could go on a medication to prevent UTIs all the time rather than waiting until I was on a trip, or was to the point of incontenence and in such pain and fever I’m down and not functioning. My urologist does not specialize in MS and while I see her reasoning in the general population, I think that for people with MS to invite any type of infection to get worse is a mistake. I’m turning 60 this year and this is working for me. The article acknowledges the problem but, as so many other MS articles offer any reasonable research about solutions. Reply Ed Tobias Hi Linda, I'm sorry about all of your UTI problems and I agree that your urologist should be treating you as someone with MS who has a URI, rather than just another UTI patient. You're also correct that I didn't report about reasonable solutions to preventing/treating UTIs. In an answer to an earlier comment I promised to do some research into that and see if I can dig up something that might help. I don't know if there is something, but I'll investigate. Stay tuned. Ed Reply Kristin Hardy Cipro has definitely been associated with spontaneous Achilles-tendon ruptures. According to my pharmacist, the recommendation to avoid taking it with calcium/dairy is because those substances block absorption of the Cipro. Another factoid that may not be shared by doctor or pharmacist is that Cipro has a very nasty drug interaction with tizanidine. According to the FDA labeling, it increases peak concentration of tizanidineby a factor of seven and a 10 fold increase in AUC, which is a measure of speed of uptake. I found this out the hard way the first time I took the two together – five minutes after taking tizanidine, my head was spinning so much I couldn't stand up. Reply Kristin Hardy Hi Linda, I had about a year and 1/2 of near constant UTIs. Here's what my urologist suggested that worked for me. The bladder lining has several mechanisms that discourage bacterial growth. When you have a UTI, particularly repeated UTIs, that structure is disrupted and can no longer protect you – UTIs are basically the gift that keeps on giving. He had me do a daily dose of Nitrofurantoin, initially for 90 days, although I eventually stayed on it for almost a year. That gave the layer a time chance to heal and reform. I also take megadose of cranberry morning and night. I know the jury is still out on whether or not it works, but he is a proponent. He also says that the supplements are more bioavailable than the juice (which is acidic and leads to incontinence issues). Now, being on antibiotics for an extended period of time is not great for you, Especially for gut bacteria. That said, Nitrofurantoin tends to preferentially locate in the bladder (my GP calls it an antiseptic for the bladder). I also keep a supply on hand so that if I have an accident or anything likely to put me at risk, I pop a prophylactic dose. Oh, and specifically go looking for a urologist who specializes in the neurogenic bladder (MS and similar). Bear in mind, this is just my experience and I don't self cath. Reply Ed Tobias Hi Kristin, That's super useful information. Thanks for sharing with the group. Ed Reply Greg Bond I have ms and underwent Lemtrada. I have never experienced UTI, but my wife has had several (she doesn’t have MS). Her gynecologist recommended drinking a glass of cranberry juice every morning and she has never had any issues since. I started drinking it as well as a preventative measure. Reply Kevin Keplinger Anyone suffering from a UTI that can't be identified, especially those on a DMT, should check for BK virus. Reply Christine Paul I also was having an issue with recurrent UTIs. I have MS and because I don’t empty my bladder, my urologist recommended using a straight catheter to make sure I wasn’t retaining, a sure lead to a UTI, if not to kidney issues. After 7 infections in a row, and trying 3 different antibiotics, which cleared the infection for a few days, but had side effects, I found a new urologist. An ultrasound showed I wasn’t retaining enough urine (in her opinion) to cath daily. She also said cranberry juice and pills were ineffective as they are too dilute and recommended taking D-mannose supplements instead. It can be purchased at many health food stores or over Amazon. It’s the active ingredient in cranberries that makes your urine inhospitable to ecoli. Also, since I was menopausal, to take a probiotic daily with a 30 billion bacteria count, as this would also affect the makeup of my urine, as a replacement for estrogen, which is a deterrent for ecoli growth. And to stop using catheters regularly. Unless I had to. And I haven’t had a UTI in almost 2 years. I know this might not work for those that must cath daily or frequently, but it might and may be worth a try. Reply Ed Tobias Thanks for sharing, Christine. That's a lot of very useful info. Ed Reply Leave a comment Fill in the required fields to post. Your email address will not be published. Your Name Your Email Your Comment Post Comment
April 19, 2024 News by Lindsey Shapiro, PhD AAN 2024: Long-term data support early Kesimpta start in relapsing MS
April 18, 2024 Columns by Benjamin Hofmeister Learning how to write a ‘SOAP’ note feels different after an MS diagnosis
April 18, 2024 News by Marisa Wexler, MS AAN 2024: Sustained myelin, nerve cell gains with long-term CNM-Au8
