Recurring UTI or reinfection? Treatments differ

       DEAR DR. ROACH: I am a candidate to have an Interstim implant done in January. My problem is that I have had to do catheterization for a long time, as my bladder does not empty due to a back injury. Over time, the nerves to the bladder have been damaged and have worsened this problem.
       During this time, I have had many urinary tract infections and have had to take antibiotics. Now it seems that the antibiotics are not working. I am on my fourth dose since October. Do you think there could be bacteria permanently on the lining of my bladder? I have had Macrobid and Cipro; the latest is Monural. Is Cipro stronger than the other two? I do not take any other medications. I am a 70-year-old female. — H.B.
       ANSWER: People who require frequent antibiotics for urine infections often develop the problem of resistance. It may require a change of antibiotics. However, the choice of antibiotic should be guided by the identification of the particular bacteria. This is done through a culture of the urine to find out which antibiotic that strain is sensitive to. There are many different classes of antibiotics, so there are many options. Most people do well for a long time.
       The key issue is to distinguish a relapse (such as would be caused by bacteria stuck on the bladder) from reinfection. If the organism is different, it’s reinfection; if it’s the same time after time, it’s most likely relapse. The two are treated differently. Relapse may require a longer course of antibiotics, or an evaluation of the anatomy. Inability to properly empty the bladder completely is a possible cause of both relapse and reinfection.
       For reinfection, the key is to reduce the likelihood of infection in the first place, if possible. In people whose poor nerve function will not allow them to properly empty the bladder, improving the bladder’s ability to empty should reduce infections.
       That said, anytime you insert a device into the body, there is the potential for the device itself to lead to infection. I looked to find results of whether the Interstim device reduces infection rate; however, I could not find any data, and I contacted the manufacturer, Medtronic, which also did not find any data on the urinary tract infection rates after the Interstim sacral neuromodulation device is placed. It is effective at reducing symptoms.
      

DR. ROACH WRITES: After a recent column in which I said diphenhydramine (Benadryl, Unisom and many others) was not my first choice for a sleep aid, many people have written to ask: What is my first choice? My first choice is to not use medication at all. Most people with occasional insomnia do well with improving their behavior around sleeping (called “sleep hygiene”). These behaviors include:
       –No caffeine after lunch.
       –Reduce or eliminate alcohol near bedtime.
       –Get regular exercise before noon.
       –Keep light and sound levels low for the two hours before bedtime (this also means little or no screen time — computer, tablet, phone, reader, etc.).
       –Avoid daytime naps: If you do nap, make it no more than 20-30 minutes, and not in the late afternoon.
       –Don’t force sleep: If you know you can’t sleep, get out of bed. You don’t want to associate your bed with frustration or worry.
       –Keep similar sleep and wake times throughout the week.
       People who still need help despite good sleep hygiene may benefit more from cognitive-behavioral therapy than from medications. If this is unavailable or ineffective, then medication trial should be based on the person’s medical condition and the type of insomnia. I’m afraid I can’t give a specific medication recommendation that would be appropriate for all of my readers.
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       Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.
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