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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17665
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I am a 60 year old female who has had Parkinson's

Resolved Question:

I am a 60 year old female who has had Parkinson's for 11years and is taking Pramipexole, Sinemet plus and Sinemet CR. History of post coital UTIs. After weekend break, irritative bladder symptoms started Monday evening. Had taken 1x100mg trimethoprim post intercourse. Started mannose and symptoms improved. Urine sample ( taken Wednesday morning) NAD including culture and sensitivity.
On Friday morning irritative symptoms worsened, now including painful contractions when urinating and macroscopic blood. Sample sent again to lab and are awaiting results. Dipstick showed leukocytes +++ and blood ++++
Trimethoprim started Friday morning - symptoms improved during the day, but on rising this morning symptoms worse and passing even more blood. Changed antibiotic to nitrofurantoin.
GP said on Friday is UTI. My concern is that, apart from when I was taking anticoagulants for a DVT, I have never passed blood with any UTI I have had.
Where do I go from here - at why stage should I push for more investigations
Submitted: 10 months ago.
Category: Medical
Expert:  Dr. D. Love replied 10 months ago.
Hello from JustAnswer. This is Dr. Love and I will be assisting you today. The fact that there is blood in the urine with a UTI is fairly common. It is not as common as having leukocytes in the urine, but it is still fairly common. The presence of blood suggests that there is a greater amount of inflammation associated with the infection, but it does not otherwise indicate any difficulty or complication associated with the infection. The usual approach is to treat the infection and only be separately concerned about the blood if it persists once the infection has cleared. The stage at which there should be consideration of whether there should be further investigation is if an antibiotic to which the germ is sensitive is not working to clear the infection. If your doctor did a culture on the urine specimen collected on Friday, then the results of the sensitivity should be available within a couple days. If the germ is sensitive to the nitrofurantoin and there is no improvement in symptoms within 2-3 days, then it would be appropriate to consider further evaluation. It is worth noting that it is common to change to an antibiotic that is different than the one used for preventive treatment. Since you used trimethoprim after intercourse as a preventive antibiotic, it was an appropriate choice to switch to nitrofurantoin without waiting for the sensitivities, since the symptoms were getting worse. On the other hand, if the sensitivities show that the germ is not sensitive to the nitrofurantoin, then it would not be surprising if you did not improve on the drug. In this situation, it would be appropriate to change to an antibiotic to which the germ is sensitive before considering a failure of antibiotics. If I can provide any additional information, please let me know.
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17665
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
Dr. D. Love and 4 other Medical Specialists are ready to help you
Customer: replied 10 months ago.
Thanks for reply - my GP has given me 50mg nitrofurantoin 4x day. Is this ok, or with the symptoms I have, would 100mg 4x day be more beneficial ( this is the dose my urogynaecologist usually uses ) bearing in mind all the other drugs I am taking for control of the Parkinson's. The amount of blood (I know even a little amount can go a long way) is scary and it seems to come and go. We have had to cancel a weeks holiday in the French Alps, as we were flying out this morning and I am certainly not well enough to travel. I would imagine that with such a severe cystitis, even if the nitrofurantoin hits the sensitive bacteria, getting away to France on Tuesday is unlikely.
Expert:  Dr. D. Love replied 10 months ago.
The recommended dose of nitrofurantoin for a UTI is 50-100 mg four times daily. I tend to use the higher dose in women with more significant symptoms and the lower dose in women with milder symptoms. And in this context, more significant symptoms would mean more severe pain or burning or systemic signs of infection, such as a fever.

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