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Dr. Y.
Dr. Y., Urologist
Category: Urology
Satisfied Customers: 18706
Experience:  I am fellowship trained specializing in general urology and reconstructive urology.
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I got sick (101.5F fever + dysuria) while traveling Monday

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I got sick (101.5F fever + dysuria) while traveling Monday 6/17, went to urgent care 6/18, diagnosed with UTI, given 500 mg Rocephin IM and Rx Cipro 500 mg 2x daily for 7 days. Started Cipro on 6/19 due to travel, immediately discovered poor tolerance of side effects (1000 mg total taken, main effect jaw pain / tooth sensitivity / headache), went to PCP on 6/21, was given Macrobid instead at 100 mg 2x daily for 7 days. Culture report from urgent care visit on 6/18 arrived 6/21, stating E. Coli positive at greater than 100,000 colony forming units per mL, susceptible to both Cipro and Nitrofurantoin (Macrobid).

Got some advice from Dr. Y on justanswer.com and on Day 7 (6/24) of illness presented lessened original symptoms (fever 98.7F / reduced burning / no urgency / no frequency) + fatigue to specialist / urologist MD.

Repeat urine culture was taken (later determined to be negative), ABX Rx switched from Nitrofurantoin (Macrobid) to Cefuroxime (E. Coli also susceptible to it) 500 mg 2x daily for 14 days. Blood tests (BMP and PSA) were taken as well, and an order for abdominal/pelvic CT scan was given.

Urologist called me on 6/27 stating that PSA was elevated to 21, other blood test was normal, and that his "guess" was I suffered a bout of acute prostatitis. Cefuroxime Rx was to be continued. He expressed no interest in culturing prostatic secretions, or ultrasound, and just stated I needed 4 more weeks of ABX. CT scan is still on order.

I have now taken Cefuroxime for 1 week. Fever is long gone, voiding issues (frequency/urgency/burning) are 95% better. However, I now have an annoying perineal sensitivity and rectal itch/fulness that make me concerned that infection may be taking hold as a chronic condition. It is Day 14 since the onset of original illness.

My question is whether Cefuroxime has a good chance of eradicating this infection. I also read that the side effect of Cipro I experienced may have been due to concurrent use of NSAIDs. Is there a significant benefit of trying Cipro again (due to its better prostate penetration), and if so, what is a safer way to administer it again given my initial reaction? Should I jump on this right away, or wait until next urology consultation on 7/8?

I don't want to risk getting a chronic condition (Macrobid detour ordered by PCP for 4 days was obviously a mistake), but am concerned about Cipro's possible side effects.

Male, Age 42, OK general health, first use of antibiotics since 2002, first incidence of UTI/prostatitis.
Submitted: 1 year ago.
Category: Urology
Expert:  Dr. Y. replied 1 year ago.
Hello and thanks for trusting me to help you today. I look forward to working with you.

These rectal symptoms are classic for prostatits. The PSA elevation is from the prostatitis and should not have been checked at this time as it is falsely elevated.

Was the bacteria sensitive to Bactrim?
Customer: replied 1 year ago.

No, culture report from original infection stated resistance to Trimethoprim/Sulfa. Repeat urine culture was negative. Assuming it is still the same infection, bacteria are resistant. Urologist was unwilling to culture EPS.

Expert:  Dr. Y. replied 1 year ago.
The bacteria is resistant to Bactrim. In this case, it is worth trying the Cipro again as this has the best tissue penetration. I don't think your side effects have anything to do with the concurrent use of NSAIDS. There is no safer way to take this Cipro. You just need to take it and see if you develop intolerable side effects again. Another alternative would be to switch you to Levaquin instead for 30 days. Hope this helps.
Customer: replied 1 year ago.

Does it make sense to insist on culturing EPS to see what bacteria are there ?


 


I assume you are pessimistic about Cefuroxime ?


 


Levaquin and Cipro have comparable safety profiles as both are fluoroquilones, no ? Would Cipro course also be for 30 days ?


 


What would abdomen/pelvic CT scan's diagnostic value be in this situation ?

Expert:  Dr. Y. replied 1 year ago.
Does it make sense to insist on culturing EPS to see what bacteria are there ?- no. The bacteria has already been identified I assume you are pessimistic about Cefuroxime ?- no I'm not pessimistic about it. It is just that Cipro has better prostate penetration.  Levaquin and Cipro have comparable safety profiles as both are fluoroquilones, no ? Would Cipro course also be for 30 days ?- yes, they are both in the same class of antibiotics and both would require 30 days What would abdomen/pelvic CT scan's diagnostic value be in this situation ?- no value. This is a bacterial infection that just needs antibiotics.
Customer: replied 1 year ago.

At this point, am I still in the acute bacterial prostatitis phase ? 30 days is for chronic prostatitis, no ?


 


How do I switch from Cefuroxime to Cipro ? Stop one/start another same day ? No antagonism ?


 


What do I do if I have a bad reaction to Cipro again ?


 


What are the comparative odds fluoroquinolone antibiotic will eradicate infection vs. cephalosporin ?

Expert:  Dr. Y. replied 1 year ago.
At this point, am I still in the acute bacterial prostatitis phase ? 30 days is for chronic prostatitis, no ? 30 days of antibiotics is used for both acute and chronic prostatits

How do I switch from Cefuroxime to Cipro ? Stop one/start another same day ? No antagonism ? Just stop one and then start the other

What do I do if I have a bad reaction to Cipro again ? Stop it and either switch to levaquin or cefuroxime
 

What are the comparative odds fluoroquinolone antibiotic will eradicate infection vs. cephalosporin ? There is no say to know this. You just have to try one and see what happens.
Dr. Y., Urologist
Category: Urology
Satisfied Customers: 18706
Experience: I am fellowship trained specializing in general urology and reconstructive urology.
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