Help! Interstitial cystitis or antibiotic resistant UTI?

[epmr]

Help!  Since this past fall, I've suffered from recurrent UTIs.  Based on the information below what is your opinion?  Interstitial cystitis or antibiotic resistant UTI?  Any other ideas?  Please note that I have an appointment with a urologist--but not for another week and I like having more than one opinion.



History:  Female, 33 yrs. old.  For the past decade, 1-2 UTIs per year directly resulting from intercourse.  One course of antibiotics cleared the infection. Can't take Macrobid. Took trimethoprom for the first time in December 2002, before that had other antibiotics.  



Starting this past fall:

October- Urine culture + for Bacteria (Enterococcus).  Given amoxicillan.  Was asymptomatic before antibiotics and not given a follow up urinalysis.    



December- Urinalysis + for bacteria (no culture performed). Home UTI test positive for white blood cells.  Given trimethoprim.  First course didn't work.  Second course resolved the symptoms. Urinalysis neg. for bacteria after second course.  After antibiotics, home UTI test neg. for white blood cells.



March - UTI symptoms after intercourse.  No urinalysis.  Home UTI test positive for white blood cells. Given trimethoprim. First course didn't work.  Given amoxicillan and symptoms resolved.



Mid April- UTI symptoms returned after intercourse.  Home UTI test positive for white blood cells.  Uncomfortable but not raging.  Drank lots of water.  Urinalysis neg. for  bacteria. Given trimethoprim.  First dose didn't work. Second dose resolved symptoms after day 5.  Took full course for a total of 6 days.  



Late April- One week later, symptoms returned.  Urine culture + for mixed gram positive bacteria.  Given Cephalexin.  I'm on day 7 of Cephalexin and still have UTI symptoms.  Home UTI test was positive for white blood cells.  



Help??  What is your opinion?  Thanks in advance for your wisdom and advice.  

[Kevin Pho, MD]

Hello - thanks for asking your question.



You note recurrent UTIs.  First, make sure that cultures are always taken when you have an episode.  Appropriate cultures and sensitivities to the antibiotics should be performed to make sure that the antibiotics are not resistant.  



There are several characteristics that make women more prone to recurrent UTIs.  These include pelvic anatomy, spermacide/diaphragm use, genetic factors (some women are prone to UTIs), and postmenopause.  



Given the fact that you have had recurrent UTIs, you may be a candidate for continuous antibiotics for UTI prevention.  Continuous antibiotic prophylaxis has been shown in studies to decrease recurrent UTIs by 95 percent.  The time course is suggested to be 2 years.  Antibiotic regimens include Bactrim and Macrobid.  



Your urologist may want to consider a cystoscopy or IVP to determine if there is any abnormality in the pelvic anatomy that may make your prone to recurrent UTIs.  



Followup with your personal physician is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Thanks,

Kevin, M.D.

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[Winterwind]

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