Opinion On Antibiotics (Sqad)

And anyone who cares to join in...

We have male 90 year old client. Enlarged prostate, so bladder doesn't empty properly. He is catheterised, but has constant UTIs. His doctor hates giving antibiotics (we'll all be immune to them in a few years). I do see his point, but he is giving our client trimethoprim (300mg?) for 7 days every 3 weeks. As this doesn't make any difference to him, we called out-of-hours a couple of weekends ago and he was given co-amoxiclav. He was better and urine completely clear within 48 hours and no sign of further infection for 2 weeks..
His regular doctor said he should not have been given co-amoxiclav at all and for this last episode has given him trimethoprim again. He has been taking it for five days now and urine still cloudy and sludgy.
Obviously, we can only give what doctor prescribed, but am interested what treatment you would give? Bladder washouts once a month too, now.
thank you!
13:53 Fri 12th Jul 2013
 
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Sqad
Best Answer
pixie....far be it from me..........but Tremethoprim is "dirt cheap" ...Co-amoxiclav is very expensive............. No.......that can't be the reason.....can it?
14:21 Fri 12th Jul 2013 Go To Best Answer

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LOL...putting me in the dock eh?

Both Trimethoprim and Co-amoxiclav are effective in UTI's in men.
I presume there was no urinalysis for culture and sensitivity.

Trimethoprim clearly didn't work........Co-Amoxiclav did.

No brainer........I would use Co-Amoxiclav....

Question Author
Yes, m'lud!
Thank you. That makes sense to me, but the regular doctor says he "must" give trimethoprim first, every time, and only give something else if that doesn't work. It never does work. I just don't understand why he thinks this way is better.
pixie....far be it from me..........but Tremethoprim is "dirt cheap" ...Co-amoxiclav is very expensive.............

No.......that can't be the reason.....can it?
Question Author
I see! No. Definitely not ;-)
I do wonder if his gp has ever had recurrent uti's. has ever had a catheter in for ages. has an enlarged prostste. ? poor man.
Question Author
Yes, i know he's had the same GP for years and the same treatment. The trouble is, also, the catheter gets blocked with sediment and he bypasses. He is in a lot of pain when that happens. Doesn't complain, but you can see it in his face. That happens always after the infection has been unsuccessfully treated. He is 90 and not too worried about becoming immune to antibiotics in years to come. It's frustrating, because we know what is going to happen, but we're not allowed to prevent it!
Sorry to butt in, but I have to say this.
People do not get 'immune' to antibiotics. Bugs do.
And it sounds as though whatever 'bug' this poor old chap keeps on getting is immune to trimethoprim. (Ghastly stuff anyway , makes you feel rotten.)

I feel extremely sorry for this old chap and wish it could be possible for him to see another GP.
As sqad says, trimethoprim isn't working, so he should be prescribed something that does.
Not much help to you, though. Sorry.
Question Author
You're not butting in at all. I appreciate all responses. I agree, but he likes to see the doctor he knows. This is why we called the out-of-hours doctor, hoping he would have a different view of it. Which he did, and it worked. However , we really can't deliberately wait for the surgery to be shut each time to see someone different!
Hi pixie Saw Palmetto is great for enlarged prostrate.
Uncomplicated UTI - trimethoprim as first treatment of choice.

Recurrent or complicated UTI - An investigation, Culture and Sensitivity to identify offending organism and determine any antibiotic resistance.

The GP is correct that prudence and caution is called for when prescribing antibiotics - but there has been a widespread incidence of antibiotic resistance developing in gram-negative bacteria over the last decade or so, which are resistent to trimethoprim. Co-amoxiclav is effective when treating those gram negative organisms that produce beta-lactamase - which is why is would be important to get an isolate and do a C&S.

If Co-amoxiclav demonstrably works, then thats probably what they should be prescribing....
Question Author
Thank you, pizza and lazygun (sorry, just back from work).
I've never heard of Saw Palmetto. What is it please? The doctor has said he will send sample to the hospital lab, but I'm not sure what they're looking for.
They will be looking to see if they can identify an organism that might be the cause of the UTI - they will be looking to isolate and culture it. (Urine is usually sterile).

Once cultured and a colony grown, samples of the colony can be mixed with a panel of different antibiotics, to determine which are effective and which are ineffective...
Question Author
Ah. So if they are checking with different antibiotic effects, we might get a different answer! The GP is saying they must give trimethoprim first every time...
Hi Pixie, I'm pizza's partner and I know a lot about herbs etc thru my bodybuilding (I own a gym). Saw Palmetto is a herb well known to stop benign hypertrophy of the prostate gland and (even) doctors are aware that it works, as I can testify thru personal experience. I'm at a loss as to why doctors don't tell all males over the age of 40 to take it but, they don't. It definitely works so is worth a try and there are no side effects. I hope this helps and good luck. If you want any more info just ask, always happy to help.
Question Author
Thank you, pizza's partner :-), I will certainly look into that.
No problems keep us informed.
p.s you can get it from any health food shops and it comes in tablet form.
Question Author
Thank you both. Interesting link too. As he is a client, I would need to discuss with him, his daughter and doctor first. But will look into it and let you know xx
Yes really Jim! it has been of significant benefit to my partner and to many he has recommended it to, like anything in life not all suits everyone but there is nothing to be lost by trying something that might benefit you.
The Consultant who treated my partner for bladder cancer was amazed at how small his prostate gland was,when my partner explained he had taken Saw Palmetta for several years the Consultant agreed that Saw Palmetta does work on keeping the prostate gland small.

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