Ten-day course of Cipro for UTI?
November 28, 2014 3:43 PM Subscribe
I was recently diagnosed with a UTI at an urgent care clinic. The PA (I did not see an MD or NP) prescribed a ten-day course of cipro to treat it (500mg, twice a day, for 10 days). That seems excessive to me (though I will take the full course of antibiotics as prescribed). Is such a long course of antibiotics commonly prescribed for UTIs?
The symptoms had been occurring on and off for a week and a half, and I was in a fair amount of pain when I went into the clinic. (Yes, I know I left it too long.) The nurse told me there was both blood and white blood cells in the urine sample I gave that day. This is the first UTI I've had in about three years, and that last UTI was the last time I was prescribed antibiotics for anything.
I do not have insurance or a primary care doctor, and the clinic told me that any follow-up would require my paying full cost out of pocket (again) for an appointment -- they don't do phone calls -- so following up with a doctor or the clinic is not going to happen.
As I said, I will take the antibiotics as prescribed regardless, but I'm just interested to know if a 10-day course is commonly prescribed in general, likely prescribed because I waited so long to see a healthcare professional, or very rarely prescribed and maybe I shouldn't go back to that clinic for care in the future.
The symptoms had been occurring on and off for a week and a half, and I was in a fair amount of pain when I went into the clinic. (Yes, I know I left it too long.) The nurse told me there was both blood and white blood cells in the urine sample I gave that day. This is the first UTI I've had in about three years, and that last UTI was the last time I was prescribed antibiotics for anything.
I do not have insurance or a primary care doctor, and the clinic told me that any follow-up would require my paying full cost out of pocket (again) for an appointment -- they don't do phone calls -- so following up with a doctor or the clinic is not going to happen.
As I said, I will take the antibiotics as prescribed regardless, but I'm just interested to know if a 10-day course is commonly prescribed in general, likely prescribed because I waited so long to see a healthcare professional, or very rarely prescribed and maybe I shouldn't go back to that clinic for care in the future.
Completely normal. Make sure you take them all!
posted by kinddieserzeit at 3:52 PM on November 28, 2014 [5 favorites]
posted by kinddieserzeit at 3:52 PM on November 28, 2014 [5 favorites]
10 days is utterly normal. It sucks, but it's true. I've been given 5- or 7-day courses of antibiotics for a UTI, but yeah, not for a bad one that had been festering for a while.
posted by Coatlicue at 4:08 PM on November 28, 2014 [3 favorites]
posted by Coatlicue at 4:08 PM on November 28, 2014 [3 favorites]
The guideline for a mild UTI is 250mg every 12 hours for 7-14 days. The guideline for a severe UTI is 500mg every 12 hours for 7-14 days. So, yeah, 500mg for 10 days is about what you'd expect for a moderate UTI.
posted by Justinian at 4:10 PM on November 28, 2014 [5 favorites]
posted by Justinian at 4:10 PM on November 28, 2014 [5 favorites]
Ten days is normal. I forget whether it was specifically Ciprofloxin I got prescribed during my last (non-self-clearing) UTI, but it was definitely a ten day course of some gnarly antibiotic horse pills.
posted by Sara C. at 4:27 PM on November 28, 2014
posted by Sara C. at 4:27 PM on November 28, 2014
IANYD, and this is not medical advice, only a general response to 'what is normal treatment for an uncomplicated UTI?'
- Cipro is a second line drug for UTI, although it is commonly used anyway. For an uncomplicated UTI, Cipro 250mg can be used for 3 days. Source: International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases.
The treatment section from UpToDate, a widely utilized resource for physicians and other providers, repeats what is in the table I linked to above and notes:
"These antibiotic options and suggested treatment durations for acute uncomplicated cystitis are the same for any adult woman with acute uncomplicated cystitis, regardless of age. A systematic review of studies evaluating treatment of cystitis in community-dwelling adults ≥65 years of age concluded that the optimal regimens are the same as those recommended for younger adults and that shorter antibiotic courses (3 to 6 days) resulted in similar outcomes as longer ones (7 to 14 days) [53].
The choice between these agents should be individualized based on patient circumstances (allergy, tolerability, compliance), local community resistance prevalence, availability, cost, and patient and provider threshold for failure. If these factors preclude use of the above antibiotics, fluoroquinolones (ciprofloxacin, levofloxacin, ofloxacin in 3-day regimens) are reasonable alternative agents, though, when possible, fluoroquinolones should be reserved for important uses other than acute cystitis [54]. Multiple randomized trials have demonstrated that fluoroquinolones are very effective for treatment of acute cystitis [42,51,55-61], although increased resistance is mitigating the usefulness of the fluoroquinolone class."
Again, this is not a commentary on your specific case, as there may be mitigating factors that would lead the practitioner to use Cipro in a higher dose or for a longer course (like a suspicion that they are not just treating uncomplicated cystitis for example). But I think it is fair to say that it would be reasonable to ask your doctor for the rationale behind getting a longer course of higher dose ciprofloxacin, just to make sure there is one.
posted by treehorn+bunny at 4:33 PM on November 28, 2014 [4 favorites]
- Cipro is a second line drug for UTI, although it is commonly used anyway. For an uncomplicated UTI, Cipro 250mg can be used for 3 days. Source: International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases.
The treatment section from UpToDate, a widely utilized resource for physicians and other providers, repeats what is in the table I linked to above and notes:
"These antibiotic options and suggested treatment durations for acute uncomplicated cystitis are the same for any adult woman with acute uncomplicated cystitis, regardless of age. A systematic review of studies evaluating treatment of cystitis in community-dwelling adults ≥65 years of age concluded that the optimal regimens are the same as those recommended for younger adults and that shorter antibiotic courses (3 to 6 days) resulted in similar outcomes as longer ones (7 to 14 days) [53].
The choice between these agents should be individualized based on patient circumstances (allergy, tolerability, compliance), local community resistance prevalence, availability, cost, and patient and provider threshold for failure. If these factors preclude use of the above antibiotics, fluoroquinolones (ciprofloxacin, levofloxacin, ofloxacin in 3-day regimens) are reasonable alternative agents, though, when possible, fluoroquinolones should be reserved for important uses other than acute cystitis [54]. Multiple randomized trials have demonstrated that fluoroquinolones are very effective for treatment of acute cystitis [42,51,55-61], although increased resistance is mitigating the usefulness of the fluoroquinolone class."
Again, this is not a commentary on your specific case, as there may be mitigating factors that would lead the practitioner to use Cipro in a higher dose or for a longer course (like a suspicion that they are not just treating uncomplicated cystitis for example). But I think it is fair to say that it would be reasonable to ask your doctor for the rationale behind getting a longer course of higher dose ciprofloxacin, just to make sure there is one.
posted by treehorn+bunny at 4:33 PM on November 28, 2014 [4 favorites]
I should also add so you understand the definition of what is being referenced above that cystitis by definition means a bladder infection (not one that has spread to the kidney, which is a pyelonephritis).
What "complicated" means (note it does not have to do with duration of your symptoms):
"Most episodes of cystitis and pyelonephritis are generally considered to be uncomplicated in otherwise healthy nonpregnant adult women. A complicated urinary tract infection, whether localized to the lower or upper tract, is associated with an underlying condition that increases the risk of infection or of failing therapy (such as obstruction, anatomic abnormality, urologic dysfunction, or a multiply-resistant uropathogen)."
posted by treehorn+bunny at 4:35 PM on November 28, 2014 [3 favorites]
What "complicated" means (note it does not have to do with duration of your symptoms):
"Most episodes of cystitis and pyelonephritis are generally considered to be uncomplicated in otherwise healthy nonpregnant adult women. A complicated urinary tract infection, whether localized to the lower or upper tract, is associated with an underlying condition that increases the risk of infection or of failing therapy (such as obstruction, anatomic abnormality, urologic dysfunction, or a multiply-resistant uropathogen)."
posted by treehorn+bunny at 4:35 PM on November 28, 2014 [3 favorites]
UTI treatment depends on how sick you look like and what other symptoms and risks you have as well as the drug resistance patterns where you live. The IDSA guidelines for pylonephritis (a UTI that has ascended into the kidney) are cipro for 7 days or 14 days of TMP-SMX (plus a 1 time IV drug unless you already have culture results). In the same guidelines an uncomplicated UTI (healthy young woman) is usually adequately treated with 3 days of either drug. There may very well be things about you that we don't know that make you a complicated UTI requiring longer treatment (like diabetes, being elderly, having abnormalities of your GU tract, kidney stones, history of drug resistant bacteria, many others).
posted by a robot made out of meat at 4:39 PM on November 28, 2014
posted by a robot made out of meat at 4:39 PM on November 28, 2014
Yes that's a standard Cipro pack for a UTI.
posted by DarlingBri at 4:59 PM on November 28, 2014 [1 favorite]
posted by DarlingBri at 4:59 PM on November 28, 2014 [1 favorite]
I had chronic UTIs for about a year or two. I am not a doctor, etc.
I definitely had some antibiotics for only 3 to 5 days, but that was because I KNEW I had a UTI right away.
With you having symptoms for over a week, I definitely think it's within line to do a 10 day course. I had on and off symptoms for about that long that turned into a nasty double kidney infection that then took over 2 weeks of antibiotics to kick.
So that's my experience anyway. Definitely want to avoid a kidney infection.
posted by Crystalinne at 5:35 PM on November 28, 2014 [1 favorite]
I definitely had some antibiotics for only 3 to 5 days, but that was because I KNEW I had a UTI right away.
With you having symptoms for over a week, I definitely think it's within line to do a 10 day course. I had on and off symptoms for about that long that turned into a nasty double kidney infection that then took over 2 weeks of antibiotics to kick.
So that's my experience anyway. Definitely want to avoid a kidney infection.
posted by Crystalinne at 5:35 PM on November 28, 2014 [1 favorite]
Mod note: From the OP:
As I said twice in my question, I will take the medication as prescribed, because I realize that the PA saw me in person and no one on MetaFilter is my doctor. Even if every single person in this thread said the PA overprescribed the antibiotics, I would still take the medication as prescribed. Can people drop that, please?posted by mathowie (staff) at 7:43 PM on November 28, 2014
As regards the rest, I'm in my late 30s, no diagnosed conditions, no worrisome symptoms of potential conditions, on no other medications, no known allergies or previous bad reactions to any medications. My blood pressure read high when the nurse took my vitals, but it's usually normal to low. I am overweight.
What I'm reading here is that this prescription is normal, but not necessarily recommended by professional medical guidelines.
I think you should ask a pharmacist what's normal for treatment of a UTI - they're happy to answer questions about medications and they know what they're talking about.
posted by aryma at 2:20 AM on November 29, 2014
posted by aryma at 2:20 AM on November 29, 2014
The idea is too make doubly sure, triply sure the organism is eradicated. There is probably a graph that will show 90% will be cured by three days, 99% by six days, and 99.9% by ten days. So is it necessary for you? Probably not. But it is to make sure resistant strains don't survive or infections don't bounce back in that 100 to 1000th person.
posted by dances_with_sneetches at 7:06 AM on November 29, 2014 [1 favorite]
posted by dances_with_sneetches at 7:06 AM on November 29, 2014 [1 favorite]
This thread is closed to new comments.
posted by infinitewindow at 3:47 PM on November 28, 2014 [3 favorites]