65 Y male who underwent Prostatectomy (weighing about 85 gm - 70 CC) got a urinary tract infection (As shown in the images attached) following the operation.Bothersome Symptoms following the operation (Hematuria that lasted more than a month but stopped) and another symptom that appeared 10-14 days after removal of the catheter (The catheter was removed two days after surgery) Burning urination (Still exists). Which antibiotic would you choose? And would you combine more than one antibiotic or monotherapy is just sufficient?
The urologist (Who did the surgery) recommended Cefepime 1 gm IM twice daily monotherapy. Is this the best choice? Or what would you choose/recommend based on this sensitivity test and history?
Also: The surgeon prescribed levofloxacin 750 mg after the surgery for 21 days. The surgery took place 7-8-2019
Past medical history:
Acetylsalicylic acid (Aspirin): 100 mg once daily
Rosuvastatin calcium: 10 mg once daily
Candesartan cilexetil: 4 mg once daily
The patient had UTI post prostatectomy with P. Aeruginosa resistant to most of antibiotics.
The urine C/S shown above was before or after administration of fluoroquinolones?
Urine C/S is the best parameter for chosing the antibiotics. Develeppement of P. Aeruginosa resistance to Cefepime and Meropenem is still low.
So, Cefepime injection (1 g/12h) or Meropenem injection (1 g/8h) are good choice for treatment of (Complicated/Non-complicted) UTI, as a monotherpay. You can add also Amikacin (if necessary) with them.
Encourages the patient to drink 2L of water and don't hold the urine (urinate every 2 hours). The ptient should not be on urethral catheter.
You need to reevaluate the ptient with hématuria (urine cytologie and fibroscopie) after treatment of this episode of UTI.
We can use combination of both cefipim and amikacin for infection according to C/S results as well as finasteride to decrease post prostatectomy bleeding for one month, and then repeat the urine culture to confirm the cure of infection
Dr.Abdelsalam, the C/S was after the administration of fluoroquinolones.
Dr. Abdelsalam KASIL and Dr.Ameer, can he use Amikacin as a monotherapy?
Post operative infections usually complicated uti.s so at this situation it is better to use combination therapy t
It's complicated UTI and the risk of resistance is raised. So, it is recommended to use combination treatment.
Monotherapy is fine with appopiate antirbiotic as per sensativites, uppertracts and bladder should be evaluated r.e. haematuria which apppears to be persistant.
Cystoscopy, Ct IVP and cuytology with repeat MSUpost compleation of antibiotics.
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