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Dr. Y.
Dr. Y., Urologist
Category: Urology
Satisfied Customers: 20143
Experience:  I am fellowship trained specializing in general urology and reconstructive urology.
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Background -89 year old female with reoccurent bladder

Customer Question

Background -89 year old female with reoccurent bladder infections -Been on Premarin 3 times a week and incurred 3 utis during this time -Last episode beginning of Nov, treated with fosfomycin -Symptoms resolved within 1 day - sensitive to all antibiotics
------ Incurred a fall on a treadmill with abrasions on Nov 3rd Within 2 weeks developed a leg infection - edema on right leg -Treated with 2000mg Keflex for 10 days -After 14 days, edema subsided with greater frequency of urination episodes with volumes of
urine -Last 4 days, upon getting up, would have urge to urinate but not high volume released, just urge to urinate -Urinalysis was negative for bact and urine not cloudy -Also drank half a beer, sourkraut, and cherries on Sunday -Urine leakage evident once
a day or so -Ceased any foods/drinks that are suspect to be bladder irritants -Person is about 30lbs overweight, mid section primarily -Fairly inactive in last month due to fall -Does some kegel exercises already What is the cause of this ailment and how to
Submitted: 1 year ago.
Category: Urology
Expert:  khagihara replied 1 year ago.

Does urine leak when you exert pressure on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy? Does she have a sudden, intense urge to urinate followed by an involuntary loss of urine? Does she experience frequent or constant dribbling of urine due to a bladder that doesn't empty completely? Does a physical or mental impairment keeps you from making it to the toilet in time?

Customer: replied 1 year ago.
Upon standing sometimes up from a sitting position is a strong urge to urinate
Other times, urge comes on suddenly WITHOUT any action or movemen
She doesn't lose urine all the time...only a bit. Perhaps 1/4 urges is there a urine loss.
She had a bladder ultrasound in Aug.
However, I have provided information above to a leg incident - edema - more urination in the last week due to this
No, my mother has no mental or physical impairment to get to the toilet.
I do believe she does have some bladder irritation
Customer: replied 1 year ago.
My mother reports this evg to have the distinctive radiating pain when urinating.
this historically has been associated with a bladder infection.
I shall be doing a urine dipstick test tomorrow morning.
Imagine it will be positive.
She just ended 2000mg Keflex for 10 days this past Thursday.
How can she have a bladder infection so early on again?
She cant have reinfected herself that quick
Expert:  khagihara replied 1 year ago.

Keflex is not so effective for gram-negative bacteria which cause UTI. She should have Nitrofurantoin, TMP-SMX, or Fosfomycin. If she has recurrent UTI, she should take antibiotics for the prevention.

Customer: replied 1 year ago.
What do you base this on that Keflex is not effective?
More than 3 previous doctors have inferred it can be used both for treatment and prevention
Expert:  khagihara replied 1 year ago.

Most UTIs are caused by bacteria called E. coli. Some strains of E. coli produce enzymes called extended-spectrum beta-lactamases (ESBL). Keflex (Cefalexin) is a beta-lactam antibiotic which has a beta-laxtum ring in its molecular structure. ESBL-producing E. coli destroys a beta-lactam of Keflex with the beta-lactamases. That could be why Kflex is not effective to her UTI.

Customer: replied 1 year ago.
this would be the case even if the urine sensitivity report confirms that Keflex is sensitive to treat the organism?
Expert:  khagihara replied 1 year ago.

The bacteria could become resistant to Keflex if Keflex has been used for a long time.

Customer: replied 1 year ago.
She was on it for only 10 days the first time ever used.
Previous cultures alrways showed it to be sensitive.
I don't think it is the problem
Do you work in at academic teaching or are you a clinician
Expert:  khagihara replied 1 year ago.

Keflex is not a first choice for UTI generally because of the efficiency. We usually prescribe Nitrofurantoin, TMP-SMX, or Fosfomycin.

Customer: replied 1 year ago.
Nitrofuran is not recommended for seniors - are you aware of that?
Are you an actual practicing doctor or a professor
Expert:  khagihara replied 1 year ago.

If her creatinine clearance is <60, it is contraindicated. If not, it is okay.

Customer: replied 1 year ago.
I shall provide you a good rating......if you open it up.
You provided some technical information but I still think you are not a clinician but a professor or something
Expert:  khagihara replied 1 year ago.

I am a clinician. I wish I were a professor in a medical school.