Post FMT bladder infections and antibiotics

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mryan63
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Post FMT bladder infections and antibiotics

Postby mryan63 » Fri Jan 24, 2014 9:41 am

Hi all
Mom had an FMT a few days ago and I was posting on another thread about her success. Well this morning she has a bladder infection and wants to call the dr. My question is.. What about antibiotic therapy following a FMT? Is it possible to relapse and get the c diff back? I am worried that this is only the beginning of a vicious cycle! I am seeing antibiotics as the enemy here!

AllisS
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Re: Post FMT bladder infections and antibiotics

Postby AllisS » Fri Jan 24, 2014 10:03 am

Hi mryan63,
It doesn't sound as though your mother has been diagnosed as having a bladder infection yet, other than by herself, though it may turn out that she's right about this. It's always possible to get a recurrence of c. difficile; FMT is not a guarantee of permanent protection. She should talk with the dr. about it, preferably the one who did the FMT. I think there's a lab test of urine that could distinguish between bladder discomfort vs. an actual UTI. It would be best to avoid an antibiotic, especially so soon after the FMT. Possibly even a mild infection would respond to lesser, non-antibiotic measures. That said, some infections do (and probably always will) require an antibiotic. (See section on this site about antibiotics.)
If your illness was preceded by use of a medication, e.g., an antibiotic, please fill out an FDA Adverse Event Report at http://www.fda.gov/Safety/MedWatch/default.htm

seekingcure
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Re: Post FMT bladder infections and antibiotics

Postby seekingcure » Fri Jan 24, 2014 2:08 pm

Several of us on here struggle with recurrent bladder infections. You don't say whether this is an isolated incident for your mom or something she deals with frequently. If it's a frequent problem, there are some things that help with prevention. One is Estrace vaginal cream, which "plumps up" atrophied tissue that can contribute to recurrent UTI's, as well as cranberry capsules taken daily (I like one by Soloray called Cranactin). I also use a simple sugar called d-mannose several times daily (get at health food store), which attracts e-coli bacteria and helps to wash them out of the bladder, in addition to Cystex liquid several times a day. Several of us also take a low dose of Macrobid (50 mg.) at bedtime to help prevent the infections. I have found that taking it with Vitamin C (I use Ester C) seems to make it more effective. One or more of these things might be helpful for your mom if this is something she deals with frequently.

As far as this current possible infection, I would definitely take a sample in and insist on a urine culture to determine whether it is actually an infection and isolate the bacteria that is causing the infection so, if an antibiotic is necessary, the proper one can be given. If the infection is caused by e-coli, it can most likely be treated with Macrobid, which is less likely to cause a c-diff relapse than others, although, as we know, any antibiotic can cause c-diff. I would be especially concerned about this so soon after the FMT, but what can you do? You certainly don't want it progressing to a kidney infection.

As Allie suggested, the best thing to do is contact the doctor who performed the FMT and discuss this with him. If it's truly an infection, sadly, probably all you can do is treat it with an antibiotic.
Bea

AllisS
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Re: Post FMT bladder infections and antibiotics

Postby AllisS » Fri Jan 24, 2014 5:47 pm

I copied the information below, about bladder infections and antibiotics, from Public Citizen's worstpills.org, which I subscribe to. Public Citizen has been around for a long time; Ralph Nader, the famous consumer watchdog, was the founder.

BEGINNING OF EXCERPT:
Bladder Infections

In a recent study of more than 13,000 women going to a doctor because of a bladder infection, more than 95% of whom had an acute bladder infection, not a recurrent one, only 37% were prescribed the preferred treatment for this condition, the combination antibiotic trimethoprim/sulfamethoxazole (sometimes prescribed by the brand name Bactrim or Septra. Almost as many (32%) were prescribed one of the heavily promoted fluoroquinolones such as ciprofloxacin (CIPRO), which are not the first-choice drug for bladder infections. Using such drugs when there is a better alternative contributes to the rapidly increasing and health-threatening problem of resistance to antibiotics, whereby when the fluoroquinolones are actually needed, people may be infected with bacteria that are resistant to them (see below). The recommended duration of treatment for an acute bladder infection is three days of the antibiotic, and yet less than 10% of the prescriptions were for three days. The most common duration of treatment was 10 days, followed by seven and five days. Thus, in addition to using the wrong antibiotic most of the time, the duration of therapy was too long most of the time.4

4 McEwen LN, Farjo R, Foxman B. Antibiotic prescribing for cystitis: How well does it match published guidelines?. Annals of Epidemiology Jul 2003; 13: 479 - 483.
If your illness was preceded by use of a medication, e.g., an antibiotic, please fill out an FDA Adverse Event Report at http://www.fda.gov/Safety/MedWatch/default.htm

seekingcure
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Re: Post FMT bladder infections and antibiotics

Postby seekingcure » Fri Jan 24, 2014 6:10 pm

Absolutely right, Allie; I think it's always better to treat a simple bladder infection with a more narrow spectrum antibiotic (providing the bacteria is sensitive to it by culture) as opposed to a broad spectrum antibiotic and three days is usually sufficient with Bactrim or Cipro. I used to take Ceftin for my recurrent infections and three days would usually do the trick. I try to avoid Ceftin now, since I've had c-diff, and Ceftin is one of the worse offenders. I believe the standard length of treatment with Macrobid is seven days. A complicated UTI might require a longer course of whatever antibiotic is prescribed.
Bea

mryan63
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Re: Post FMT bladder infections and antibiotics

Postby mryan63 » Tue Jan 28, 2014 11:07 am

I apologize for being so vague in my previous post. This has been so overwhelming for me. Mom is a diabetic and therefore susceptible to recurring bladder infections. Her sugar is not very controlled mostly due to poor eating habits. She is on both pills and insulin at night for this and she doesn't quite get it that she needs to eat right. Having that said, I believe that the constant bladder infections and frequent use of antibiotics is the reason she contracted the c diff to begin with. She does take macrobid at night for maintenance and just recently restarted it due to her being on the Vanco and flagyl prior to the FMT.

She went to the dr yesterday to get a urinalysis done and we are still waiting on results. For now she is taking AZO to deal with pressure and pain. We will have to see what her dr comes up with and then make that decision on whether or not to take the antibiotic he prescribes. She will take it providing the risk is low for recurring the c diff. I will certainly take all of your advice and look into these alternative treatments for prevention of bladder infections and hope mom will listen to me. ( she is a stubborn lady). Thank you all for your input and advice, it helps me tremendously! Btw we did contact Dr Josephs nurse practitioner and she is not really happy that mom may need an antibiotic for fear that the FMT may not be effective. We did discuss the pros and cons and she was very helpful as well. Again thank you all for your input, I will post again when I have more info and let you know the outcome. Maybe it will be beneficial and informative for someone else too. :)

seekingcure
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Re: Post FMT bladder infections and antibiotics

Postby seekingcure » Tue Jan 28, 2014 1:22 pm

I am diabetic also and this definitely contributes to my frequent bladder infections.Try to get her to drink a glass of water immediately before bed and avoid anything with sugar in the evening. I seem more likely to wake up with a bladder infection if I eat something with sugar and forget to drink my water at bedtime. Interestingly, if I drink a glass of milk at bedtime that also seems to set the stage for an infection. The last bad infection I had (when I first got c-diff) my doctor put me on a ten day course of Macrobid. That did not clear the infection and I ended up having to take 10 days of Cipro (one of the bad offenders for c-diff) to get rid of it. I was on Vanco at the time. Since then I have started the Macrobid 50 mg. at night, along with all the other preventative things I mentioned. It might seem like overkill, but my urologist knows what I'm taking and said if it works then do it. Infectious disease doctor doesn't really like the idea of me being on the Macrobid long term, even at a low dose, saying that it will affect the gut bacteria. At this point, however, I don't have any choice. It's better than having to take stronger antibiotics every month or two.

When a person has diabetes and/or recurrent UTI's, they are not considered "simple" infections, according to my urologist. They are complicated infections that often require longer courses of antibiotics than the standard three-day treatment that someone with a simple, acute infection could take. However, the last infection I had, I was able to clear with the over-the-counter remedies I mentioned along with my macrobid 50 mg. at night and an extra 50 mg. macrobid in the morning, plus some extra vitamin c (makes the urine acidic and bacteria does not like an acidic environment). I also take the Macrobid at night now along with two 500 mg. Ester C. This seems to be working for me currently, knock on wood. I'm not sure Vitamin C would be advised, though, so soon after her FT as it might affect the good bacteria somewhat also, so be sure to check with her doctor that did the FT before adding any vitamin c, or any of the other over-the-counter remedies I mentioned. Don't want to affect that good bacteria getting established if you can help it.

I hope some of this is helpful to you in trying to help your mom. I know how frustrating these recurrent UTI's can be, especially when c-diff is also in the picture and it's best to avoid antibiotics. Unfortunately, sometimes there is nothing we can do but take them to avoid a kidney infection, which can also be life-threatening.
Bea


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