Suggest Medications For Vaginal Pseudomonas Inspite Of Having Vesico Ureteric Reflux

Posted on Sat, 22 Mar 2014

Question: My 5 month old daughter contracted vaginal pseudomonas. I am not sure how the contamination happened, but she does have kidney disease and is on prophylaxis (amoxicillin) for it. She has also been catheterized several time for urine tests (VCUG, cultures, etc). Her specific issues are reflux, which is still being diagnosed as there are some other issues as well. My family has history of severe genetic abnormalities in the urological tract from dual sided duplicating ureters, megaureters, neurogenic bladder and sphincters to kidneys simply not working correctly. My eldest daughter was a mess and had many corrective surgeries as she was constantly in the hospital from pseudomonas in her urine. She almost died on us several times turning blue from urinary sepsis. I could smell the infection on her each time before she was diagnosed and hospitalized and put on gentamicin cocktails prescribed by an infectious disease doctor. The only thing that kept her out of the hospital was Cipro, which she was on and off for 3 years until the age of 5. When I smelled that familiar smell it in her youngest sister's diaper my chest constricted. Unlike my eldest daughter, there was a yellowish/green mucous discharge that seemed to periodically ooze from her vagina. I made sure to take her to the pediatrician and had a urine test done and had the also had them run a culture on the mucous. I was relieved to find out that there was no UTI, but weirded out to hear it was in her vagina. I know that regardless of how clean I keep her, the fact that she has a health issue and her being on long term medicine could be a factor. I am taking her to the urologist who I assume will be putting her on a different medication trail to kill the bacterial contamination and then switch her back to the Amoxicillin. My question is, what the heck would a doctor put her on as she is so young? Hopefully not a fluoroquinolone? The whole milk thing is a pain in the neck and the other possible side effects that this medication can cause are not comforting - she is plain too young for this medication. My eldest daughter was one of the youngest put on Cipro with special permission of an ID doctor. My pediatrician also suggests going to a pediatric Gynecologist which completely weirded me out. I do not want her being touched by too many people unnecessarily, especially not before following up with the urologist. Any advice?

Answered by Dr. Deepak Kishore Kaltari (3 hours later)

Brief Answer: Pseudomonas infection is non invasive Detailed Answer: Hi Welcome to Healthcare-Magic Greetings of the day Being a Parent and Pediatric Surgeon I do understand your concern and apprehension. I routinely look after many Pediatric Urology cases. Coming to the issue of your daughter. As you said she has Vesico Ureteric reflux. Normally urine stored in the urinary bladder does not go back into the ureter , this is possible due to valve like action of significant length of ureter being present in bladder. Less length being present predisposes to reflux. Many of the younger children who demonstrate reflux usually improve over period of time. As she is only 5 months ( I would like to know the grade of reflux) it's very much likely that she will improve over next couple of years provided chemo prophylaxis is religiously given. It's also important to know the individual renal function and rule out renal scarring by doing Radionucleotide Renal Scan ( Discuss it with your Pediatric Urologist/Pediatric Surgeon). Coming to the presence of Pseudomonas in vaginal secretion. The good thing is Urine is free from any infection and there is no fever. Also in the absence of systemic signs like fever , isolation of Pseudomonas from vagina just means colonisation by bacteria without active infection. If such a patient presents to me, I would do the following 1. Good clinical examination of the Vaginal opening: Normally there are two opening seen , The above one is urethral opening and lower one is vaginal opening. It is important to rule out Urogenital Sinus ( only one opening seen, urethra opens in the vaginal wall only and no separate urethral opening seen). Presence of Urogenital Sinus predisposes to colonisation. So would suggest you to discuss this with your Pediatric Surgeon. 2. Treatment: As it's non invasive infection ot will require only local treatment. Ciprifloxacin is reserved for severe invasive cases and resistant cases. I routinely advise Hot seitz bath with 2 spoons of Vinegar (it has anti Pseudomonas action). To a tub of lukewarm water add handful of common table salt and add two spoons of vinegar. Baby can be made to sit in it for 15 minutes each time twice a day. Rest be assured things can be taken care Do get back to me if you need any further assistance, will be glad to assist you. Take care Best Regards Dr Deepak Kishore MBBS, MS, MCH Consultant Pediatric and Neonatal Surgeon

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