From the Guidelines
For an 83-year-old male with Parkinson's disease, history of bladder cancer, recurrent UTIs presenting with acute gross hematuria and chills, and normal renal function, the best antibiotic choice would be nitrofurantoin. The recommended regimen is nitrofurantoin monohydrate/macrocrystals 100 mg twice daily for 5-7 days 1. This antibiotic provides excellent coverage against common urinary pathogens, including those that may cause UTIs in patients with a history of bladder cancer. Given the patient's susceptibility to cephalexin, macrobid, and tetracycline, nitrofurantoin offers a different class of antibiotics that may be effective against resistant organisms. Some key points to consider when using nitrofurantoin include:
- Monitoring for potential side effects such as nausea, headache, and diarrhea 1
- Ensuring adequate hydration during treatment
- Considering urine culture before initiating therapy if possible, though treatment should not be delayed if the patient appears septic
- Being aware that nitrofurantoin may not be as effective against more severe or complicated infections, and adjusting treatment accordingly It's also important to note that while ciprofloxacin is a viable option, the potential risks associated with fluoroquinolone use, such as tendon issues and CNS effects, may make nitrofurantoin a more suitable choice for this patient 1.
From the FDA Drug Label
Patients should be followed carefully so that any side effects or unusual manifestations of drug idiosyncrasy may be detected. Cephalexin should be administered with caution in the presence of markedly impaired renal function.
Clostridium difficile Associated Diarrhea Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including tetracyclines, and may range in severity from mild diarrhea to fatal colitis.
nitrofurantoin (macrocrystals)
The best antibiotic choice for the patient is cephalexin.
- The patient has normal renal function, which reduces the risk of adverse effects associated with cephalexin.
- Cephalexin is effective against the suspected bacterial infection and the patient is susceptible to it.
- Tetracycline has a higher risk of adverse effects, such as photosensitivity and intracranial hypertension, and its use is generally avoided in certain patient populations.
- Macrobid (nitrofurantoin) is not fully described in the provided drug label, but it is often used for urinary tract infections. However, based on the information provided, cephalexin is a more suitable choice for this patient 2.
From the Research
Patient Profile
- 83-year-old male in long-term care with Parkinson's disease
- Remote history of bladder cancer and recurrent urinary tract infections (UTIs)
- Acute gross hematuria and chills
- Susceptible to cephalexin, macrobid, and tetracycline
- Normal renal function
Antibiotic Options
- Cephalexin: a first-generation oral cephalosporin that has been shown to be effective in treating uncomplicated lower urinary tract infections (uLUTIs) due to non-extended-spectrum beta-lactamase-producing (ESBL) Enterobacteriaceae 3
- Macrobid (nitrofurantoin): an antibiotic that is commonly used to treat uncomplicated UTIs, and its use is not discouraged in elderly patients or those with impaired renal function 4, 5
- Tetracycline: a broad-spectrum antibiotic that is effective against a wide range of bacteria, but its use may be limited due to resistance and side effects
Considerations
- The patient's normal renal function suggests that nitrofurantoin (macrobid) may be a suitable option, as its efficacy is not significantly affected by renal function 4, 5
- Cephalexin may be a good alternative, given its effectiveness in treating uLUTIs and its convenience of administration 3
- The patient's age and medical history should be considered when selecting an antibiotic, as elderly patients may be more susceptible to side effects and may require dose adjustments 6