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Vakul Aren
Vakul Aren, Doctor
Category: Urology
Satisfied Customers: 3565
Experience:  MBBS,DTM&H
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I am looking doctor or clinical pharmacist with

Customer Question

I am looking for a doctor or clinical pharmacist with competence/expertise in Infectious Disease as it deals in urology issues-Bladder utis
-oral antibiotics - resistance
-competition of asymptomatic bacterium vs symptomaticYou need a competence in this area.....
So individuals such as Dr Phil, Dr Prick or Dr Thomas need NOT answer
Submitted: 11 months ago.
Category: Urology
Expert:  Vakul Aren replied 11 months ago.

Hello,I am DR. Aren and I have been dealing with such problems for over three decades in my clinical practice.Please do let me know more about your query.

Customer: replied 11 months ago.
There are many doctors fielding answers that really have no substance.
So I shall present the situation. I have enough of a science background to decipher if I am getting a generic goulash responseBackground
1. 89 year old mother with history of chronic bladder infections
2. Has not received a proper urological assessment to date - may get one in the next few months to rule out structural issues
3. 2.5 years on nitrofuran with no bladder utis but ceased in early 2014 due to liver enzymes which went down
4. 1 year on fosfomycin with only 1 breakout incident, never confirmed if ecoli became resistant to drug due to lab's omission
5. Ecoli with counts of greater than >100E6 are typical with - radiating torso pain, incontinence and urgency
6. 2015 - she ceased fosfomycin as new righteous family doctor thought topical estrogen would be the silver bullet
7. Bladder uti free til June, then the episodes began
- JUNE - lab confirmed ecoli, treated by 5 day Bactrim - resolved
-August - suspect bladder uti, treated by 1 fosfomycin sachet
-Early Nov - lab confirmed ecoli, treated by 1fosfomycin sachet
-Mid Nov - mother incurred a fall on treadmill, leg abrasion resulted in leg infection
-10 days on Keflex at 2000mg
-5 days after stopping Keflex, had a lab confirmed ecoli and ENTEROCOCCUS symptomatic
-Took 5 days of Bactrim and symptoms resolved - took drug from Dec 4 to 9th
-Symptom free
-Resumed 3gram fosfomycin as preventative for ecoli on Dec 11
-Family physic***** *****ged
-New routine blood sample/urine sample submitted which was negative for leukocytes - Dec 14
-Mother has had no symptoms this past week other than in the beginning of the week -urine urgency/incontinence
-Last 5 days, symptom free - normal bathroom activity-
-However lab sample came back with 10 - 1006 enterococcus and lab only provides generic statement that
bacteria generally susceptible to amox and nitro
-New doctor stated no more antibiotics til she is seen by uro - even for preventionMy concern deals with that theoretically the Bactrim and/Fosfomycin didn't get rid of the enterococcus but the problematic
ecoli was gone. She is currently symptom free. Would giving a drug like fosfomycin continue to clear the ecoli but create
more favourable conditions for the enterococcus to thrive? Can the enterococcus actually be a good thing and impeding
the ecoli OR all of a sudden make her symptomatic.She takes a strong therapeutic probiotic daily and the last 2 year urine cultures for at least ecoli - there is no resistance
to any common antibiotic. However no data is known for fosfomycin. The drug has minimum side effects.I live in Canada and public health care stinks. Every ding dong plugs the local doctors office and ER as its all free....My mother also has diverticula pouches and though has a stocky muscular build - is 20lbs overweight in midsectionThankyou for your insight
Customer: replied 11 months ago.
no personal urine sensitivities are known for enterococcus.........as Canadian labs are quite lazy in many facets
Expert:  Vakul Aren replied 11 months ago.

Infection, either with E. coli or enterococcus is not normal.It would be prudent to use a short course of Linezolid to clear the enterococcus,Tedizolid is also effective and both can be used orally.Better care for vaginal and anal hygiene will help prevent frequent reinfections with e.coli,washing and wiping from front to back rather than the other way around,preventing soiling by faecal incontinence and maintaining excellent care and hygiene will help .The fact that she is currently free of any E coli infection is very good news. Bactrim can be used safely for any fresh infections,longer courses may help clear any persistent infections.

Customer: replied 11 months ago.
Dr Aren:
You provided me once good advice a few years ago..
What you conveyed makes sense but I already know that.
The Linezolid is not used in this grand nation....
I realize the enterococcus shouldnt be there...
However - here you dont treat nonsymptomatic bacteria
I needed specific information on the significance of the enterococcus and how that might compete with the problematic ecoli and the whole aspect of asymptomatic bacteria vs symptomatic ones.
So please opt now - thankyou
Expert:  Vakul Aren replied 11 months ago.

Asymptomatic enterococcus will not protect from E.coli infections,not treating asymptomatic infection which may also be a contaminant of faecal soiling/leakage is not the answer to managing recurring infections.Better care and hygiene of the genital area will help.Further investigations and ruling out urinary bladder structural abnormalities by a cystoscopy and other investigations will help.low dose Bactrim is often used as a preventive for E. coli and to eliminate low level infection.

Customer: replied 11 months ago.
Please opt out....
I think there are established guidelines in various countries throughout the world - you don't treat asymptomatic urinary infections. So you are wrong on this. As mentioned before too many doctors out here answer questions where they don't have the right expertise in that speciality
Customer: replied 11 months ago.
Correct that sentence - you don't treat a person without symptoms -just because you find an given bacteria in their urine

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