Is more than cipro needed for this UTI/kidney thing?
September 11, 2008 6:02 AM   Subscribe

Starting to freak out about whether a UTI has spread to my kidney, and whether the antibiotics I have are enough. Supposed to be on a LONG plane ride in a day to a place where I don't speak the language and may not get good medical care. Help please?

I *have* seen a doctor, but I still need some help. Monday I was prescribed Bactrim for UTI symptoms because the first pass analysis looked pretty clean (no blood, low leuks, but they didn't culture), so they weren't sure I even had anything. Today I went back in since things were still unpleasant. After a "sensitivity" culture, they (finally!) determined that the bacteria is not only present, but is Bactrim resistant. I was given a prescription for 7 days of Cipro, and took the first one 3 hours ago.

I'm freaking out because for the last hour or so, my left lower back has been hurting. Not insanely, but enough so that I'm noticing. I'm supposed to fly halfway across the world on Friday. A UTI that's being treated is ok. A kidney infection probably isn't. If I'm ALREADY on Cipro, is the possible progression from UTI to kidney something that requires another doctor's trip? Is there more they could/would do for me? Should I be considering canceling my trip?

I'll go in to the doctor tomorrow morning, particularly if it still hurts. But any advice would help me get to sleep tonight.
posted by anonymous to Health & Fitness (17 answers total) 1 user marked this as a favorite
I've had a kidney infection from having a UTI. You're already on antibiotics so whatever infection in your kidneys and urinary tract will be knocked out so I wouldn't worry. Just take the medicine as prescribed and finish the entire bottle, even if you think you feel better. When I had my kidney infection, it was really bad. I could barely walk or even stand because the pain was horrendous. They gave me a shot of antibiotics just to get them into my bloodstream as fast as possible, then just prescribed me some oral antibiotics and sent me on my way. If I were you, I wouldn't worry since you're already taking something for your UTI. The reason my UTI spread to my kidneys was because I was young and didn't know what a UTI was. I had a burning sensation when I peed for a few weeks but I was too embarrassed to talk about it with anyone. Well, needless to say, I was forced to talk about it eventually when it spread to my kidneys.
posted by MaryDellamorte at 6:21 AM on September 11, 2008

If you are feeling agitated about it I would call the doctor and get a second prescription of Cipro to have on hand, just in case. In general, Cirpro has knocked out the evil UTI's I've gotten, but having a second, more aggressive batch of antibiotics on hand when you are about to go abroad is generally a good idea. If you are in a lot of discomfort waiting for the antibiotics to kick in, ask for Peridum, it's the stuff that turns your pee bright orange but usually makes the UTI pain decrease significantly.
posted by 8dot3 at 6:26 AM on September 11, 2008 [1 favorite]

*This is not medical advice and I'm not a doctor*. Cipro has been well-studied as a treatment for kidney infections and is regarded as effective for them - as the kidney infection is most likely caused by the same bacterium as your UTI, it should clear it up.

Having said that, if you vomit up any of your tablets you need to get to a hospital stat, as you might need IV antibiotics if you can't keep tablets down.

If it were me and I had time to go the doctor on the morning of the trip, I'd go to the doc just for peace of mind - but I think you'll probably be OK.
posted by altolinguistic at 6:29 AM on September 11, 2008

Seconding 8dot3, great idea to get a backup script.

Cipro has also conquered my UTIs, but at considerable cost to my gastrointestinal flora - be warned. I'm sure it will work for you, but be prepared for the worst stomach cramping ever in the entire universe. But you'll be healed, so it is all good.

Pyridium is available OTC as well - just make sure you don't take it for more than 3 days.

Good luck, and have a great trip!
posted by Punctual at 6:30 AM on September 11, 2008

I'd call the doctor's office and ask to speak to the nurse. This is what nurses do, so take advantage of the whole healthcare team in that office. S/he will tell you whether you need to come back to the office or not, what to watch out for, etc. Be sure to tell her that you are going on a trip Friday.
posted by selfmedicating at 7:09 AM on September 11, 2008

My back hurts sometimes with particularly awful UTIs. The "makes your pee orange" stuff is OTC in the US - AZO is a good one. Otherwise, the advice about getting an extra course are good, but Cipro is not a drug to be misused - it's not something you want to develop a resistance to.
posted by Medieval Maven at 7:39 AM on September 11, 2008

I think you will probably be ok, but IANAD. What I would do however, it get a translation of whatever you would need to tell the Dr. in the foreign country before you leave. Including all your test results and what medication you are on. Also, print out a list of where all the western hospitals are located. Then if you do get worse you don't have to worry too much about being able to get adequate treatment. Also, don't let yourself get dehydrated on that flight. In my experience at least, 3rd world docs are great at treating anything you can throw a wide spectrum antibiotic at, especially things that are fairly routine like a UTI (even a bad one). So just be prepared and know where you need to go if things get worse.
posted by whoaali at 7:40 AM on September 11, 2008

Another thing to check for short-term reassurance: Do you have a fever? I would be more likely to suspect kidney infection if I had a substantial fever. At any rate, go back to the doctor as planned.
posted by PatoPata at 7:56 AM on September 11, 2008

I did have UTI turned kidney infection, but I had other symptoms too-- fever, nausea, etc. (It isn't always because an initial UTI isn't treated either; it was my first, but I knew exactly what it was, went right in, and it still happened.) In any case what they gave me for it was Cipro, which IIRC took maybe two days or so before it really helped.

That having been said, as I'm sure you know, plane trip is going to suck. Although it probably hurts, drinking lots of water on the flight is required. You might try to get an aisle seat because you'll probably want to be up all the time.

Also things to remember: Presumably you know you must take all of your course, even if you feel better in the next 3 minutes. As said above, you really really dont' want to breed bacteria resistant to Cipro.

And if I were you I'd buy a big pack of cranberry pills before you go. They won't cure an already present UTI, but they will help prevent a new one from forming. For me these things are magic. If you really want an experience get some of the 100% cranberry juice (not the cocktail). It's a bitch to drink but it always makes me feel better.

If you are worried about the travel, would it be possible to get a translation of your issue written down? i.e. what infection you had, what it was resistant to (they might have checked more than just the bactrim), and what you were treated with. That way if you *do* have problems you have a way to communicate what's wrong.
posted by nat at 8:15 AM on September 11, 2008

This is what I would do (I am a doctor, but not your doctor etc etc...).

When you visit your doctor again, ask them prescribe you another course of ciprofloxacin or norfloxacin to cover you while you are away, and ask if they can prescribe you a pack of urine dipsticks. They can easily teach you how to use the dipsticks to check your own urine when you are away. A dipstick that shows positive for nitrites (and a to a lesser extent leucocytes) is a strong indicator that you either still have a UTI or have another UTI and need to take further antibiotics and/or visit medical services in the country you are travelling to.

Your doctor should help you make the decision whether you should fly. I personally would probably not risk flying if there is any indication of a developing kidney infection. A long dehydrating flight is going to be miserable if your UTI is not under control by tomorrow.
posted by roofus at 8:15 AM on September 11, 2008

(on lack-of-preview, whoaali already mentioned the translation idea.. but I think that's because it's a good one!)
posted by nat at 8:18 AM on September 11, 2008

I second roofus' suggestion of urine test strips. They are available online and even here on ebay for less than $20. I bought some a year ago, and it was not just an investment in my own health but a classy touch of decor for my bathroom.

I bought generic strips and they work nicely. They even tell me all kinds of fun trivia like the specific gravity of my pee.

In tests for UTIs I have never received a false negative, but I have had false positives when leukocytes turned up because I didn't do a proper clean catch. I guess that's not so much a false positive as a case of geting in touch with my white blood cells which may also stay around around briefly after an infection has already cleared.

In my experience, Cipro works quickly, but it can take a full day before I've noticed any effects so hopefully you will be feeling better soon. I have also had trouble with dehydration and crystals in my urine even after an infection has cleared so I agree with nat that drinking lots of water is crucial. Pyridium, the magic orange pee drug is remarcably effective at making the pain go away, but you might want to hold off on it if you are using the pain to guage whether the antibiotic is working.

Good luck and feel better!
posted by abirae at 9:07 AM on September 11, 2008 [1 favorite]

Cipro's blood level is the same whether given orally or IV. I remember an intern bringing this fact up on rounds once. The professor said, "Good, so give it IV."

The point, which I was not to learn for many years, was not that the antibiotic was going to be more efficacious given IV; it is that Medicare will not reimburse for hospital stays if nothing is being done that could not be done at home. This particular patient was pretty sick and unlikely to comply even with a simple antibiotic regimen at home, so the prof figured a way to justify the hospital stay so this large, underfunded city hospital could get reimbursed for this particular patient.
posted by ikkyu2 at 9:10 AM on September 11, 2008

(...and if you don't feel better by tomorrow morning by all means see your doctor. I've found that when I've said the magic words "U-T-I" to my doctors' receptionists, they've always been able to squeeze me in quickly. You'd be surprised how many people can empathize and nobody likes a kidney infection.)
posted by abirae at 9:15 AM on September 11, 2008

As Punctual said, cipro can be murder on the happy bacteria balance throughout your body. Since you're going to be abroad, it might be a very good idea to proactively pack medications for that potential poo-tastic side effect. Also, if you're a women, grab some yeast infection cream. Cipro has always resulted in one when I've taken it and I would not want to be in a foreign pharmacy trying to figure out what correct treatment was.
posted by mostlymartha at 11:50 AM on September 11, 2008

If I'm ALREADY on Cipro, is the possible progression from UTI to kidney something that requires another doctor's trip? Is there more they could/would do for me?

Certainly. If you fail cipro treatment because your infectious bug is Cipro-resistant, or you don't finish your entire course of your medications, you could get a kidney infection (pyelonephritis), require a different antibiotic, or hospital admission for IV antibiotics.

If they got a culture it sounds like your bug is Cipro sensitive. But yes, repeat visits do happen for any number of reasons.
posted by gramcracker at 12:04 PM on September 11, 2008

Echoing again the suggestions to put a call into your doctor and ask about getting a back-up script.

Keep in mind, also, that the less regulated the medical care in the country you're going to, the easier it will be for you to buy cipro (probably as generic under the full name ciprofloxacin) over the counter. In my own experience with third-world-doctors, this is exactly the sort of thing they're good at treating-- bacterial infections they can toss a bunch of antibiotics at. If you're really concerned about having to seek treatment when you get where you're going, you might want to pick up a travel medical kit (try a drug store or travel store) with disposable needles and syringes. Peace of mind if you end up in an unsanitary-looking clinic.
posted by bookish at 1:45 PM on September 11, 2008

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