Important information about antibiotic resistance

The following is from Dr Steven R. Goldstein, an expert NYC gyn, to his current patients. Please note that the following information is not a substitute for in office diagnosis and treatment. It is meant for informational or educational purposes only.

Most of you are aware that I usually only send email blasts when something has appeared in the news or print media that I think would be of important interest to you and worth sharing. 

Approximately two weeks ago, there was an article in the Science Section of the New York Times speaking about drug resistance (actually, in a gastrointestinal situation), which “has scientists worried.” Obviously, I don’t primarily treat gastrointestinal infections (diarrhea, irritable bowel) but many of you often do and should call me when you think you have a urinary tract infection. What I am going to explain now I have related to a handful of you face-to-face in the office. I think, however, this is worthy of wider distribution. 

When penicillin first came out in the 1940’s, it killed almost all bacteria. Today, it kills very few bacteria. This is because many bacteria have become resistant to its use. Antibiotic resistance is a natural occurrence caused by mutations in bacteria’s genes. However, inappropriate overuse of antibiotics accelerates the emergence and spread of antibiotic resistant bacteria. When a patient does have symptoms of a urinary tract infection (burning with urination, frequent urination, feeling like one has to go and can’t, suprapubic pain, and sometimes even bloody urine) increasingly, many healthcare providers, especially those at “urgent care,” will do a dipstick of the urine and if it contains a substance called leukocyte esterase, they presume a bacterial infection and will give a broad spectrum antibiotic that should kill anything that might be present. I finally had happen something that I had predicted for more than a decade. In the not so distant past, I have had two patients who had confirmed urinary tract infections based on a culture and sensitivity test. Such a test not only identifies the actual bacteria and number of colonies present, but also will give a long list of various antibiotics and whether this particular bacteria is susceptible or resistant to each of these antibiotics. These two patients had confirmed urinary tract infections that were resistant to virtually every oral medication that we normally give. Their bacteria was sensitive to medications that would be intramuscular or intravenous. I had to call these patients and tell them that I treat urinary tract infection almost as a courtesy, and that I was not about to give a big shot in the buttocks or hang an IV of a drug that I have no experience with (since they were resistant to all the usual oral medications) and that they would have to go to urology to be treated for their urinary tract infection. Clearly, it is the overuse of antibiotics that has resulted in the rapidly emerging resistance to common oral medications.

The preferred way to handle suspected urinary tract infection would include a urinalysis and formal urine culture with sensitivities. While this takes forty-eight hours for a result, there are medications (like Uristat, or Pyridium) which are actually urinary anesthetics. They are so effective at masking the symptoms of urinary tract infection that when I was a resident at Bellevue, we did not utilize such medications because in such patients their symptoms were so masked that they felt they were cured and did not do any follow up. If a patient starts such a urinary anesthetic, it is essential to simultaneously run a urine culture. If the culture is negative, then the diagnosis is “sterile trigonitis.” In these cases, the trigone of the bladder becomes inflamed. “-Itis” represents inflammation of and not true infection. Such a situation can be treated with one week of one of these urinary anesthetics and an antibiotic is not necessary. If such a culture and sensitivity shows bacteria being present, then I like to choose the least broad spectrum antibiotic for that particular bacterial strain. 

Obviously, we live in the real world, and if someone calls me on a Friday afternoon about to leave on vacation for a week with symptoms of a urinary tract infection, I may be forced to give an antibiotic because we do not have the luxury of obtaining a culture and waiting forty-eight hours. Hopefully, most of you understand the logistics of what I am trying to explain.

If you think you have a urinary tract infection, please contact the office. We can arrange for medication to relieve your symptoms (these urinary anesthetics) and order an appropriate urinalysis and urine culture and sensitivity, assuming we have adequate time for results. This will be appropriate for you and help prevent development of resistant organisms “down the road.”

Dr Steven R. Goldstein is a leading Gynecologist in NYC. If you are not a current patient, but suspect you have a urinary tract infection you may schedule a consultation for an examination.