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Info - Antibiotics and their medical implications

This is written from our own experience of lessons learned the hard way.

Most people, when they suffer their first few episodes of cystitis, go for a medical cure - in other words, antibiotics. Initially, the antibiotics can be very effective, especially if you have never had cystitis before. However, with every additional infection, that particular antibiotic is likely to become less effective, as the bacteria builds up resistance.
Every time you have another episode of cystitis, therefore, it tends to be worse than the time before, and then you have a real dilemma. Doctors who are naturally and correctly wary of prescribing antibiotics are unlikely to want to give you a more powerful dose, which means that some of the infection is likely to survive, effectively allowing the E.coli to develop resistance, until standard antibiotics like Trimethoprim will no longer work. Meanwhile, your episodes of cystitis last longer and longer, and they are likely to begin causing kidney damage, and a lot of persistent pain.

At this point, (in the absence of Waterfall D-Mannose®), you will need more powerful broad-spectrum antibiotics to try to solve the problem. And at first these will work. However, the wily E.coli continues its process of resistance until stronger and stronger broad-spectrum antibiotics are required to kill the infections, and these cause their own particular problems.

Note: To be fair to doctors, if they wait to get laboratory results before prescribing, your infection could be much worse by then, but proper investigation of serious UTI's involves testing cultures of the bacteria found in the urine against a variety of antibiotics, both in isolation and combination, to find the most effective narrow spectrum antibiotic or combination. However, this test is much more costly and takes longer than simply prescribing broad spectrum antibiotics, and so the tests are rarely performed. In most cases, urine tests for UTI infection simply involve identifying the infection, and the doctor will prescribe an antibiotic that is known to be effective against that particular bacterium, in a non-resistant form. This, however, takes no account of bacterial resistance.
Mohamed H. Dahir - Chairman Pharmaceutical Association of Somaliland, The Dangers of Indomethacin:
"If a bacterium is responsible, it is extremely important for the doctor to know which specific bug is causing the trouble so that he can treat it with the right drug. Using a broad-spectrum antibiotic is a cop-out. It is the lazy way to do medicine, since it allows the doctor to cut out the time necessary to do a proper laboratory work-up and diagnosis."

Others will (perhaps) test for the presence of E.coli, and then prescribe antibiotics without taking previous infections into account. They'll treat each infection as a new infection, instead of as a reinfection, or as a recurrence of the same infection, despite the fact that antibiotics leave 21% of women with vaginal E.coli still present after 6 weeks (see below). So they'll give you the same dosage as last time, and if it's the same bug you were fighting before, that's been living quietly in your urinary tract just waiting for your immune system to go down a bit to allow it to start multiplying again, or for you to have sex and shake some E.coli loose from their protected place underneath their bio shield on your bladder wall, it will take that antibiotic longer to kill the infection, helping the bug to build up resistance.

Read the Drug Watch study for more information. What becomes clear is that rather than testing your particular infection to determine the most appropriate treatment, patients are treated statistically. You are statistically more likely to respond to trimethoprim-sulphamethoxazole, so that is the first antibiotic that most doctors choose - it is also, conveniently, the cheapest antibiotic, and hence the cheapest way for a doctor to attend to your infection. And most of the time they can order the cheapest tests - just testing for the presence of an infection.

Note also that (in the absence of Waterfall D-Mannose):

"Trimethoprim-sulphamethoxazole proved to be the best treatment, with 82% of women cured at the six-week visit, and with the lowest remaining incidence of vaginal E coli (21%). Adverse events were reported by 35% of patients treated with trimethoprim-sulphamethoxazole, similar to other treatments. " Drug Watch

Note the huge number of women (35%) with adverse effects, and compare this to over 90% of infections cleared by Waterfall D-Mannose, and 0% of patients suffering adverse effects. The presence of E.coli after using Waterfall D-Mannose is not known, but what is known is that if you take Waterfall D-Mannose, even after being treated for cystitis with strong antibiotics over an extended period, a huge amount of E.coli is flushed out of your urinary tract. This strongly suggests that many fewer women will be left with E.coli after taking Waterfall D-Mannose, than after taking antibiotics. And we know from a huge amount of user feedback that Waterfall D-Mannose prevents recurrence of the problem in most cases. The longer you've been taking it - the less often threats of cystitis occur, so it does seem to make the bladder very healthy over time.

How likely are you to get side effects?

Here's an extract from a clinical trial outlined on RXList:

"In this trial, the overall incidence rates of adverse events regardless of relationship to study drug and within 6 weeks of treatment initiation were 41% (138/335) in the ciprofloxacin group versus 31% (109/349) in the comparator group. The most frequent events were gastrointestinal: 15% (50/335) of ciprofloxacin patients compared to 9% (31/349) of comparator patients. Serious adverse events were seen in 7.5% (25/335) of ciprofloxacin-treated patients compared to 5.7% (20/349) of control patients. Discontinuation of drug due to an adverse event was observed in 3% (10/335) of ciprofloxacin-treated patients versus 1.4% (5/349) of comparator patients. Other adverse events that occurred in at least 1% of ciprofloxacin patients were diarrhoea 4.8%, vomiting 4.8%, abdominal pain 3.3%, accidental injury 3.0%, rhinitis 3.0%, dyspepsia 2.7%, nausea 2.7%, fever 2.1%, asthma 1.8% and rash 1.8%."
Not all of the observed side effects are listed.

Antibiotic side-effects

The stronger the antibiotic you take, as a general rule, the worse the side effects. The side effects of broad-spectrum antibiotics, and in particular Fluoroquinolone based antibiotics such as Ciprofloxacin can include, but are not limited to the following:

• Cardiovascular - Heart attack, heart murmur, palpitations, angina, cerebral thrombosis, sudden death on first dose.
  
  
• Nervous System - Convulsive seizures, psychosis, depression, hallucinations, paranoia, insomnia, nightmares, dizziness.
  
  
• Gastrointestinal - Liver failure, jaundice, gastrointestinal bleeding, diarrhoea, ulcerative colitis, burst intestine, vomiting, constipation.
  
  
• Muscles and Bones - Tendon seizure, tendon bursting and ripping, jaw, arm or back pain, joint stiffness, neck and chest pain, aching all over, gout.
  
  
• Kidneys and Urinary Tract - Kidney failure, calcification in kidneys, urethral bleeding, severe thrush, vaginitis.
  
  
• Lungs - espiratory arrest, blood clotting in lungs, shortness of breath, pulmonary edema (lung collapse), hiccough.
  
  
• Skin/Hypersensitivity - Anaphylactic shock, skin sloughing (falling off), dermatitis, skin death, vasculitis, angioedema, swelling of the lips, eyes, or face, fever, chills, going purple.
  
  
• Sensory disturbances - Blurred vision, eye pain, disturbed vision, hearing loss, dizziness, tinnitus, involuntary eye movements, damaged sense of taste.

Immune system effects

When you take antibiotics, your immune system can become weakened, meaning that you are more prone to infection than before you took the antibiotics. So the infection may be killed, but you get reinfected easily. When this is combined with reinfection with a more resistant strain of the bacteria that caused the original infection, it can be very difficult to deal with.

Broad spectrum antibiotics are more likely to damage your immune system, so as time goes on, and you become infected with more and more resistant strains of (usually) E.coli, you find it not only harder to fight off each infection, but harder to prevent yourself becoming reinfected. Eventually, no matter what you do, even if you are clean to the point of obsession, like almost everyone who has suffered repeated episodes of cystitis, you still get infected. This is often because the bacteria have been living in your gut or urinary tract, just waiting for your immune system to be at its lowest, allowing it to breed rapidly and take over your body once again.

Wipe from front to back? No wonder you want to say to the doctor, "Listen pal, you could safely eat your dinner off my bottom! My infection has nothing to do with my personal hygiene."

Thrush - Candida Albicans

The stronger the antibiotic, as a rule, the worse the episode of thrush you get afterwards. Eventually, the thrush can become as persistent and almost as painful as the cystitis, because the fungus builds up resistance to the treatments you use against it.

Symptoms of Vasculitis

Vasculitis of varying levels of severity is one of the listed side effects of some broad spectrum antibiotics commonly used for the treatment of cystitis. It is caused by immune reaction that can disrupt DNA and RNA, and put white blood cells on the attack against your own body. Lupus-like effects are common.
Symptoms can include, but are not limited to:

• Skin - Red or purple dots, usually most numerous on the legs. When the spots are larger, about the size of the end of a finger, they are called "purpura." Some look like large bruises. These are the most common vasculitis skin lesions, but hives, itchy lumpy rash, and painful or tender lumps can occur. Areas of dead skin can appear as ulcers, small black spots appear at the ends of the fingers or around the fingernails and toes, or you may get gangrene of fingers or toes.
  
  
• Joints - Aching in joints and obvious arthritis with pain, swelling and heat in joins. Deformities resulting from this arthritis are rare.
  
  
• Brain - Vasculitis in the brain can cause many problems, from mild to severe . They include headaches, behavioural disturbances, confusion, seizures, and strokes. May be fatal.
  
  
• Peripheral Nerves - Peripheral nerve symptoms may include numbness and tingling (usually in an arm or a leg, or in areas which would be covered by gloves or socks), loss of sensation or loss of strength, particularly in the feet or hands.
  
  
• Intestines - Vasculitis can cause inadequate blood flow in the intestines, resulting in crampy abdominal pain and bloating. If areas in the wall of the intestine develop gangrene, blood will appear in the stool. If the intestinal wall develops a perforation, surgery may be required.
  
  
• Heart - Vasculitis may affect the coronary arteries. If it occurs, it can cause a feeling of heaviness in the chest during exertion (angina), which is relieved by rest. Heart attacks rarely occur as a direct result of vasculitis.
  
  
• Lungs - Vasculitis in lung tissue can cause pneumonia-like attacks with chest x-ray changes that look like pneumonia, and symptoms of fever and cough. Occasionally, inflammation can lead to scarring of lung tissue with chronic shortness of breath.
  
  
• Eyes - Vasculitis can involve the small blood vessels of the retina. Sometimes, vasculitis of the eyes causes no symptoms. Usually, however, there is visual blurring which comes on suddenly and stays, or a person may even lose a portion of their vision. In temporal arteritis, there is sudden loss of part or all of the vision in one eye, usually accompanied by severe headache.  

Distribution

From a Ciprofloxacin Product Label

"After oral administration, ciprofloxacin is widely distributed throughout the body. Tissue concentrations often exceed serum concentrations in both men and women, particularly in genital tissue including the prostate. Ciprofloxacin is present in active form in the saliva, nasal and bronchial secretions, mucosa of the sinuses, sputum, skin blister fluid, lymph, peritoneal fluid, bile, and prostatic secretions. Ciprofloxacin has also been detected in lung, skin, fat, muscle, cartilage, and bone. The drug diffuses into the cerebrospinal fluid (CSF); however, CSF concentrations are generally less than 10% of peak serum concentrations. Low levels of the drug have been detected in the aqueous and vitreous humors of the eye."

Research

Cipro Label extract: [http://www.fda.gov/ohrms/dockets/ac/00/backgrd/3632b1a_04.pdf]

Lucas MJ, Cunningham FG: Urinary tract infections complicating pregnancy. In: William's Obstetrics. 19th ed. 1994: 1-15.

H.M.I. Osborn, J.J. Gridley, "Recent advances in the construction of beta-D-mannose and beta-D-mannosamine linkages", J. Chem. Soc., Perkin Trans. 1, 2000, 1471-1491.

Schieve LA, Handler A, Hershow R: Urinary tract infection during pregnancy: its association with maternal morbidity and perinatal outcome. Am J Public Health 1994 Mar; 84(3): 405-10.

Sweet RL, Gibbs RS: Urinary tract infection. In: Infectious Disease of the Female Genital Tract. 3rd ed. 1995: 429-64.

CDC Special Report : "Emerging Mechanisms of Fluoroquinolone Resistance" David C. Hooper Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Fuchs S, Simon Z, Brezis M: "Fatal hepatic failure associated with ciprofloxacin" Lancet 242:738-739 (1994).

InsightsandOutcomes.com - Article 194 : Health Researchers, Physicians Express Concern About Rising Antibiotic Resistance.

Read more at RX List.com
Read more at Healthsquare.com
Read more at Tips of All Sorts
Read More at Better Health
Read More (Vasculitis Article 000874) at Medline Plus