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Dr. Gott: Are antibiotics always good?

DEAR DR. GOTT: I get frequent UTIs, especially after intercourse. How do I convince my doctor that a low-dosage refillable antibiotic instead of a seven-day treatment is the way to go for my situation?

I have taken to saving a pill or two from my prescription so that when I feel the onset of an infection, I can take one pill and drink plenty of water to thwart a full-blown episode.

Also, what is your opinion on D-Mannose as a treatment? I read about it online and am considering giving it a try. I can’t drink cranberry juice because I have also been diagnosed with interstitial cystitis, and the acid irritates my bladder.

DEAR READER: Urinary-tract infections are common and are the cause of more than 8 million visits to the doctor every year. The kidneys, ureters, bladder and urethra make up the urinary system. The kidneys remove excess amounts of liquid and waste from the blood in the form of urine, balance salts and other blood substances, and help form a hormone that produces red blood cells. The ureters are narrow tubes that carry urine from the kidneys to the bladder, where it is stored until emptied through the urethra. An adult passes approximately 48 ounces of urine each day.

Generally speaking, urine is sterile – meaning it is free of viruses, bacteria and fungi. However, an infection can occur when bacteria enter and multiply in any part of the urinary tract. UTIs most commonly occur in the bladder or urethra and as the result of the bacterium Escherichia coli, or E. coli. When the bladder is affected, a condition known as cystitis (inflammation of the bladder) may occur. Cystitis can also occur without infection. If not treated properly (in a timely manner, with appropriate antibiotics or for a long enough period of time), the infection can back up into the kidneys, a condition known as pyelonephritis. Kidney infections can be difficult to treat, requiring extended courses of antibiotic therapy and possible hospitalization. Complications of untreated pyelonephritis include kidney damage and a life-threatening spread of the infection into the bloodstream.

Women are more prone to frequent UTIs than are men, and almost 20 percent of the women having a UTI will have another one. Of that amount, 30 percent will have another, and a whopping 80 percent will have a recurrence from that group. Even when E. coli is to blame, there are differences in the bacteria present, indicating diverse infections. This process alone may be why your physician will not give you a standing order for an antibiotic. It is, however, an acceptable practice to give women a refillable prescription for a single, low-dose antibiotic to be taken immediately following intercourse to prevent an infection.

Drinking plenty of fluids to help flush bacteria from your system, emptying the bladder soon after intercourse, and avoiding irritating feminine-hygiene products may help you prevent an infection. Instead of sitting in a tub, take a shower. Avoid caffeine, alcohol and spicy foods when you experience any symptoms. Because of your history, you should talk to your physician about what other options you have, rather than waiting until a full-blown infection occurs. Perhaps a referral to a urologist is in order.

The D-Mannose to which you refer is a simple sugar for the treatment of UTIs and is relatively new to the herbal market. It is a naturally occurring rare saccharide in some plant and food substances and, depending on the concentration of bacteria present, is purported to reduce symptoms in 24 to 48 hours and clear them in three days. Many of the products marketed appear to have 400 milligrams of cranberry extract added to enhance its effectiveness. I can neither endorse nor pan the product because I don’t know enough about it. If you choose to proceed, be careful to check the ingredient label before purchase.

Readers who would like related information can order my Health Report “Bladder and Urinary Tract Infections” by sending a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Dr. Peter Gott and mailed to P.O. Box 433, Lakeville, CT 06039-0433. Be sure to mention the title or print an order form off my website’s direct link at www.askdrgottmd.com/ order_form.pdf.



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