I had started another post for today but after tweeting about Mum’s recurrent UTI decided to change to this topic in the hope of sharing our experience and possibly learning from others.
Are antibiotics the answer to recurrent UTIs?
Warning -it might be a little TMI for some. I’m sharing our experience but always seek medical information from your doctor!
Background
Mum has Alzheimer’s, diabetes and has a spinal condition that means she is wheelchair dependent. Most of the day is spent on a recliner or the bed where we conduct her personal care. As mum is unable to walk she does wear incontinence pants that need to be frequently changed.
She takes several medications to help treat her condition that also causes constipation, and so to counteract that she takes laxatives to improve her bowel movements.
UTIs
A UTI is a urinary tract infection commonly known as a bladder infection. You can read more about it from the Mayo Clinic. Mum has experienced several UTIs this year more than the norm, probably aggravated now by the development of her diabetes and worsened due to personal care issues.
To put it simply bacteria are getting into the urinary tract primarily from faecal incontinence spreading within her incontinence pants. In most cases, we deal with incontinence as it happens but due to mum’s spinal condition, she isn’t always able to tell me when it happens. And so bacteria is spread despite our best efforts and sometimes it develops into a UTI.
The right approach?
One of the things you learn when dealing with dementia is to be wary of a UTI causing delirium and how harmful that is to the individual. So I’ve always been vigilant on knowing when mum isn’t herself (with dementia) and when she could be experiencing increased confusion either being hyperactive or hypoactive or a mix of the two.
In mum’s case, it’s usually increased confusion, urine odour /colour, urinary frequency etc. It’s difficult to tell as she’s been going through bouts of drowsiness and falling asleep. So when I combine that with mum’s other symptoms I call our doctors to rule out a UTI.
The first stage in getting a UTI diagnosed once you experience symptoms is to provide a urine sample which is complicated until I started to learn new methods of collection. You can read more in my post How to get a Urine Sample from someone with Dementia?
Some of the samples I submitted were compromised, but the doctor still just prescribed antibiotics and I didn’t think to object until recently. I didn’t question the fact they always gave her antibiotics even when no urine sample could be provided (note: she never once had a fever).
As her dementia caregiver and advocate I let her down, and I’m now surprised looking back why the doctor always prescribed antibiotics given the number of health–related issues mum has.
In the last few instances, they have been able to identify the bacteria from the sample given, but unfortunately, she’s become resistant to most of the medication and as she’s allergic to Penicillin so her options are limited.
Last week, the doctor wanted to give mum antibiotics straight away without knowing the urine sample results because it was Friday and wouldn’t be processed until after the weekend. I insisted on waiting as mum’s symptoms to me weren’t severe.
Midweek, the doctor called saying she needs to be prescribed Penicillin related antibiotic and literally as he saying the name of it, he must’ve been reading mum’s notes and seen her allergy to Penicillin. Then he was stumped and just said to increase her fluids and see if it will pass on its own. He advised to contact them immediately if certain symptoms arose but otherwise really wait and see.
Push Back on Antibiotics?
I’m not saying it’s the wrong thing to use them, but you should definitely talk over your options with your doctor. Each case is different, but always consult, because if a UTI is not properly treated then it could lead to complications and potentially develop into the worst case scenario of getting sepsis, which is life threatening.
There are a lot of factors for your doctor to consider especially your age & other health conditions, allergies, symptoms etc. Your doctor may only have 10-15mins to talk things over with you.
One of the things I used to keep is a spreadsheet/diary of when mum had a UTI and what meds were prescribed, and recovery time. If you have something like this you can point out to your doctor, the number of times antibiotics have been prescribed and details of current symptoms compared to previous cases.
I’m not a doctor so always ask them the question. The last thing I want is people ignoring medical advice, but there is nothing wrong in asking, & making sure they know exactly the symptoms & the history.
Alternative Therapies?
I wish I’d educated myself better on not just delirium but antibiotic resistance. I realise now our options are always going to be limited now. If we’d used a wait see approach in all those cases where no sample was available because they were compromised, we may have reduced the chances of mum becoming resistant.
Now I’m going to be focusing on other methods to try and prevent a UTI from developing. I’m not sure some of these other preventative treatments will work, like estrogen cream, cranberry juice, D-Mannose etc. because of the way mum develops them. Always check for any side effects and talk to your doctor before making any changes e.g cranberry juice can interfere with Warfarin, so you’re advised not to take it.
In the meantime, I’m going to request a referral to the bowel and urinary consultant.
I’ve had some excellent advice, but interested to hear about your experience of recurrent UTIs and how you deal with them?
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