Hi doctor, This deals with my mother, who has a history of chronic E. coli bladder infections. She has been on preventative antibiotics and topical estrogen. Recently, she was eight months UTI free with being on 2000 mg mannose sugar daily. Her eGFR was 65 around six months ago. I reduced the sugar down to 1500 mg. About a week ago, she developed some UTI symptoms. Historically, she would get incontinence, urgency and a distinctive radiating pain shooting up torso when she peed. However, this week, she had only the symptom lightly once in two days in a row. Otherwise, she had no other symptoms. I have attached the urine sample report. I also have urinalysis strips. On the day of the laboratory sample, the strip was positive for nitrites, but nothing for RBCs or leukocytes. We increased her mannose to 3 g for two days and then 2 g for three days. Then, the dipstick test showed leukocytes, nitrites and RBCS 200. Today, two tests showed traces or negative nitrites (3 hours bladder retention). However, the RBCs are still high at 200 and the urine sample showed a pink tinge. I have been given approval by a urologist to give my mother Fosfomycin. My mother's E. coli in the past have shown resistance to Bactrim, Amoxicillin, Ampicillin, etc. She has no symptoms at this point other than being more tired and she is 90. Someone told me if nitrites are getting less, she might be able to get over this incident without a formal antibiotic. She does take 15 mg Xarelto daily. It was ceased last night, but taken today again. Is Xarelto playing a factor here? She also used to take estrogen cream more regularly, but now once a week if she remembers it. She had spot bleeding on her underwear a few months ago around once or twice and an ultrasound showed nothing. She has an ovarian cyst.She drinks 1 to 1.25 liters of water daily. We are just trying to gauge the significance of the blood in the urine. She has no specific urinary symptoms, but more sleepy overall. Thank you.
Hi. I have gone through the history and the reports sent by you (attachment removed to protect patient identity). For further information consult a urologist online -->