Most people, when they suffer their first few episodes of cystitis, seek a medical cure in the form of 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 gradually build up resistance. And we have reached the point in 2017 when no one could fail to be aware any longer of the concerns regarding antibiotic resistance. Jim O Nell who chaired the review panel looking at this problem warned that by 2050 antibiotic resistance could result in 10 million deaths a year. He suggests that doctors resist prescribing antibiotics until they have carried out tests to prove the infection is bacterial:
"We must stop treating antibiotics like sweets, which is what we are doing around the world today."
Doctors are very aware of these concerns and are unlikely to want to keep prescribing more powerful antibiotics without extensive lab testing. Because if E.coli develops resistance, standard antibiotics like Trimethoprim may no longer work. When that happens, your episodes of cystitis could last longer and have the potential to develop in to kidney infections. Thorough 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.
It is clear that this is of worlwide concern.
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."
However, testing is costly. And worse for the patient, it takes time. When someone is clearly ill, broad spectrum antibiotics may be deemed necessary immediately. Common sense dictates that if doctors wait to get laboratory results before prescribing, an infection could develop rapidly and you become very sick indeed, so it is hard for both patients and their doctors.
Sadly, we talk to people every day who have acquired resistant strains of bacteria that are no longer responding well to antibiotic therapy. ESBLs are an example of this.
ESBL-producing bacteria have joined the growing number of antibiotic resistant pathogens that cause hospital-acquired infections. ESBL bacteria are different from other superbugs, because ESBL does not refer to one specific kind of bacteria. For instance, MRSA refers specifically to methicillin-resistant strains of Staphylococcus Aureus whereas ESBL's (Extended Spectrum Beta Lactamases) are enzymes made by bacteria such as Klebsiella and E. coli, both common culprits in urinary tract infections (UTIs). This enzyme beta lactamase is an antibiotic-resistance enabling enzyme that the bacteria produce to protect themselves from attack.
Usually, ESBL's are harmless and live in the body without causing infection. But when ESBL's get into a part of the body where they do not belong, like the blood or bladder we may experience serious problems.
Reported side effects of broad-spectrum antibiotics, and in particular Fluoroquinolone based antibiotics such as Ciprofloxacin, may be rare but are varied.
The stronger the antibiotic, as a general 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.
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 reported.
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 humours of the eye."
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.
Sweet Cures ’ Anna talks about her battle with cystitis. Read More
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