DEAR DR. GOTT:
I am a 64-year-old female. I would like your opinion on my current urinary problem. For the last two years I have had recurring bladder infections. My primary physician sent me to a urologist who has done every available test. I have had X-rays, MRIs, scrapings and bladder emptying tests. They found that I have a kidney stone but it doesn’t appear to be bothering anything so it was left alone.

When these infections first started, there were several antibiotics that seemed to work. Now there is only one, Macrobid 100 mg. I take it two times a day for a full course immediately followed by Bactrim 400/80 mg once every night. My urologist said the Bactrim is supposed to “clean” my urine while I sleep.

I have followed these instructions for more than a year now. This therapy does not work. Three to five days after I finish the Macrobid, I have another infection! I am very worried about my kidneys. Will they eventually get infected too? What will happen when the Macrobid stops being effective? I have asked these questions of my urologist and the response is that only time will tell. Please help.

DEAR READER:
You appear to have a resistant chronic infection. This means that the infection is not being completely eradicated after finishing the course of Macrobid. This may be happening for several reasons. The most likely cause is that you are not being given the medication long enough. This could also explain why the infection is not responding to as many medications as it previously was. (If an antibiotic repeatedly fails to kill all the bacteria, they will eventually build up a resistance to it, making the medication ineffective.) Another possibility is that the infection is already in your kidneys. Kidney infections can be very difficult to treat because antibiotics do not readily penetrate the outer layers. A final option is that you have a combination infection. For example, the bacteria were not eliminated properly, built up a resistance to every antibiotic but Macrobid, moved into your kidneys and are persisting. In either case, I believe that you should take an extended course of antibiotics. Rather than the standard 10-day course (which I assume you receive on a regular basis), your urologist should try a one or two month course followed by testing to ensure the infection has been eliminated.

As an aside, the Bactrim does not appear to have any effect on your infection, if symptoms return after the Macrobid is stopped. Speak to your urologist about discontinuing the medication.

If your urologist is unwilling to listen to your concerns and make some appropriate changes to your current treatment, you should find someone else. A new physician will also bring a new perspective to the situation and may have other suggestions or treatments. If you decide to make the change, I recommend you seek out someone who is well-versed in chronic or recurring bladder infections in women.

This situation is not best handled by a wait-and-see format. Without proper treatment, the infection will only worsen. You need a physician willing to try different options.

Good luck and let me know how this turns out.

To give you related information, I am sending you a copy of my Health Report “Bladder and Urinary Tract Infections”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.