What should I do if I have hematuria while taking ciprofloxacin (Cipro) and metronidazole (Flagyl) for colitis?

From the Guidelines

If you experience hematuria while taking ciprofloxacin and metronidazole for colitis, you should immediately contact your healthcare provider for prompt evaluation and guidance. This is because hematuria can be a sign of a medication side effect, urinary tract infection, or another underlying condition that requires medical attention 1. When reaching out to your doctor, be prepared to provide detailed information about the onset of bleeding, its appearance, and any accompanying symptoms such as pain or burning during urination, as well as your current medication regimen. It's crucial not to stop your antibiotics without medical advice, as treating your colitis is a priority. Hematuria can occasionally occur with ciprofloxacin due to crystalluria or hypersensitivity reactions, while metronidazole less commonly causes urinary issues 1. Your healthcare provider might recommend increasing fluid intake, temporarily adjusting your medication, or scheduling an urgent appointment for further evaluation. Key considerations in managing your condition include:

• The importance of not ignoring blood in your urine, as it necessitates proper assessment to determine if it's related to your medications or indicates another medical concern requiring treatment.
• The need for prompt medical evaluation to address potential complications or side effects associated with your current treatment regimen.
• The role of your healthcare provider in guiding adjustments to your treatment plan, which may include changes to your antibiotic therapy or the addition of other interventions to manage your colitis and address the hematuria. Given the most recent and highest quality evidence, the AGA clinical practice guideline on the management of pouchitis and inflammatory pouch disorders published in 2024 1 provides the most relevant guidance for your situation, emphasizing the importance of prompt medical evaluation and individualized management of your condition.

From the FDA Drug Label

Crystals of ciprofloxacin have been observed rarely in the urine of human subjects but more frequently in the urine of laboratory animals, which is usually alkaline. Alkalinity of the urine should be avoided in patients receiving ciprofloxacin. Patients should be well hydrated to prevent the formation of highly concentrated urine

If you have hematuria (blood in urine) while taking ciprofloxacin (Cipro) and metronidazole (Flagyl) for colitis, you should:

• Contact your healthcare provider immediately to report the symptom.
• Stay well hydrated to prevent the formation of highly concentrated urine, which may help prevent crystalluria.
• Your healthcare provider may need to assess your renal function and adjust your treatment accordingly.
• It is essential to follow your healthcare provider's instructions and attend any scheduled follow-up appointments to monitor your condition. 2

From the Research

Hematuria while taking Ciprofloxacin and Metronidazole for Colitis

• The presence of blood in urine, also known as hematuria, can be a concerning symptom, especially when taking medications like ciprofloxacin (Cipro) and metronidazole (Flagyl) for colitis.
• According to a study published in 2014 3, metronidazole can cause urine discoloration, which may be mistaken for hematuria.
• The study reported a case of a patient who developed cola-colored urine while receiving metronidazole for Clostridium difficile sepsis, and the urine color returned to normal when the medication was stopped.
• However, it is essential to note that the study did not find any clinically adverse effects associated with the urine discoloration.

Potential Causes of Hematuria

• Hematuria can have various causes, including urinary tract infections, kidney stones, or other medical conditions.
• In the context of taking ciprofloxacin and metronidazole for colitis, it is crucial to investigate other potential causes of hematuria, such as:
  • Urinary tract infection: Ciprofloxacin is an antibiotic that can help treat urinary tract infections, but it may not be effective against all types of bacteria.
  • Kidney damage: Metronidazole has been reported to cause kidney damage in rare cases, which may lead to hematuria.

Management of Hematuria

• If you are experiencing hematuria while taking ciprofloxacin and metronidazole for colitis, it is essential to consult your healthcare provider for proper evaluation and management.
• Your healthcare provider may order additional tests, such as urine cultures or imaging studies, to determine the cause of hematuria.
• Based on the underlying cause, your healthcare provider may adjust your treatment plan, which may include changing your medication or adding new medications to address the underlying condition.

Relevance of Studies

• The studies provided do not directly address the issue of hematuria while taking ciprofloxacin and metronidazole for colitis.
• However, the study published in 2014 3 highlights the potential for metronidazole to cause urine discoloration, which may be relevant to the symptom of hematuria.
• Other studies, such as the one published in 1980 4, report cases of colitis associated with metronidazole therapy, which may be relevant to the underlying condition being treated.