How to treat recurrent UTI?

Question

Hi Doctor,

This is regarding my friend's dad, aged 76-years-old. He has had recurrent urinary tract infections in the past three months, and every time the culture shows up, some bacteria, I guess, E. coli. He also strains while passing urine and has weak power (stream).

He has also already taken Nitrofurantoin, Augmentin duo, and Levobact 750 mg, but the recent culture still shows E coli. He has had high blood pressure and diabetes for the past 20 years, but well-maintained fasting blood sugar is usually between 80- 100 mg/dL, and BP is usually between 120 to 130 mm Hg.

He does not have a burning sensation while urinating, fever, pain in the back, or has never seen blood in the urine. He is currently taking Urimax 0.4, Telma AT, Amlong 5 mg, and Glucomet tablets.

Our doctor said there can be some blockage or obstruction, and has suggested some tests like PSA and CT Urography. Please go through the attached reports and clear our doubts. Also, I have a few concerns:

Why is he always having infections and RBC in his urine?
Why is it not going away after taking powerful and costly antibiotics?
How to treat early renal parenchymal disease as seen on Ultrasound?
He has albumin 80, creatinine 50, and Serum creatinine is 1.2 in urine. What does it signify, and how to treat it?
Should we also do PSA and CTU as costly tests?
What treatment do you advise?

Please suggest.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

I will answer your questions. He is always having infections and RBC (red blood cells) in urine, which means whenever he has a UTI (urinary tract infection), pus cells and RBC are bound to come. Sometimes the organism is resistant to oral antibiotics, so we have to switch to injectables.

Moreover, sometimes antibiotics have to be taken for an extended period, say three months.

The treatment of early renal parenchymal disease, as seen on ultrasound, is by strict control of diabetes or hypertension, as well as proper UTI treatment. Albumin can occur in UTIs and in diabetics. Once it gets settled, albumin should also be corrected.

Sometimes, even with very good control of diabetes, albumin can come. Urine and serum creatinine levels are normal. Lastly, I think you should have these tests done, as not all pathologies can be picked up in ultrasound.

The treatment I would advise you is: if there is a recurrent UTI, I will further investigate him based on CT (computed tomography) and switch to an injectable plus oral antibiotics combination. His post-void residual urine is significantly high, so I suggest you take tablet Urimax D HS (Tamsulosin 0.4 mg and Dutasteride 0.5 mg) for life.

I hope you find this helpful.

Thank you.