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Hi Doctor, My Mother-in-law Developed High Fever On 8th Sep

Posted on Sat, 6 Oct 2018

Question: Hi Doctor,
My mother-in-law developed high fever on 8th Sep and chills. Her stomach was upset too. She took Norflox-TZ for 3 days and paracetamol.
Fever came down after that but urine test suggested UTI.
Attached are her blood test reports and urine test/culture.
Doctor gave antibiotic for 5 days but meanwhile culture report came through today. Could you please take a look at the blood/routine urine/urine culture report and suggest the right antibiotic for her ? Also pls suggest if she should get any additional tests done ? Thanks.

Answered by Dr. Dr. P. T. Patil (1 hour later)

Brief Answer:
She needs to be given Tigecycline twice daily for five days

Detailed Answer:
Hello
Thanks for query .
Based on the facts that your mother in law has developed UTI and the urine culture report that you have uploaded reveals bacterial infection which are resistant to almost all antibiotics that are commonly used in UTI except Tigecycline .

Tigecycline is very costly antibiotic casting about 1900 per vial the dose of the same being twice daily for five days.The cheapest brand available in XXXXXXX is Tigez by Lupin laboratory

You may add Nitrofurantoin twice daily as one culture report issued by SRL diagnostics reveals bacteria sensitive to Nitrofurantoin .

The cause of UTI in elderly females is mostly due to what is called as Senile Urethral Stenosis which causes incomplete emptying of bladder duering urination that results into significant amount of urine to remain in bladder This post Void Residual urine is the source of infection.

Consult qualified Urologist for clinical examination and get following basic tests done to confirm the diagnosis. .
1) Ultrasound scanning of abdomen and pelvis
2) Endoscopic Examination of bladder (Cystoscopy and Urethral Calibration )

Hope I have answered your query ,please feel free to ask if you have more questions,I shall be happy to help you
Thanks and Regards.
Dr.Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (1 hour later)

Thank you Doctor. So I presume you are suggesting we give her Tigecycline and Nitrofurantoin both.Or since it is sensitive to Nitrofurantoin , can we try giving it and then repeat culture after couple of days and if the infection remains we can give Tigecycline?

thanks

Regards
Rakul W

Answered by Dr. Dr. P. T. Patil (7 hours later)

Brief Answer:
You can give her Nitrofurantoin twice daily for 10 days .

Detailed Answer:
Hello
Thanks for query .

The dilema regarding giving Nitrofurantoin is due to discripancy in urine culture report issued by two laboratories .

The report from SCL diagnostics states it to be sensitive to Nitrofurantoin whereas report from Lal Pathology shows it to be resitant to Nitrofuraantoin .

In a given circumstances and considering the high cost of Tigecycline I would suggest you to give her Nitrofurantoin twice daily for 10 days and repeat the urine culture after 10 days and take a call to prescribe antibiotic as per report at that particular time .

Thanks and Regards.
Dr Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (6 hours later)

Thanks Dr XXXXXXX Cost is not an issue, as her bills gets reimbursed from government. it is just that it has to be administrated intravenously however we will go with Nitrofurantoin as per your suggestion for now.

Should we give anything in addition like Alkasol or Uriliser in addition to antibotic course? thanks

Answered by Dr. Dr. P. T. Patil (15 minutes later)

Brief Answer:
You can give alkalizer Citralka thrice daily

Detailed Answer:
Hello
Thanks for follow up .

You can give urine alkalizer Citralka thrice daily .

Thanks and Regards.
Dr Patil.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar