By Jill Heidi Osborne MA, May 28, 2015

When the symptoms of interstitial cystitis and prostatitis virtually mimic that of a bladder infection, it’s only natural for patients and doctors to contemplate treating the urinary symptoms with an antibiotic. Go ahead! Admit it! You’ve probably raided your medicine cabinet in the middle of the night to take an antibiotic that you’ve saved. You might have even ordered antibiotics off of the internet. A desperate, burning bladder or prostate calls for desperate measures, right? Wrong!

#1 – Infection rarely causes IC or prostatitis flares. Interstitial cystitis patients rarely are positive for infection and only 7% of the men who visit their doctors for prostatitis have active infection. The remaining 93% have other things going on in their pelvis, such as interstitial cystitis, pelvic floor dysfunction, pudendal neuralgia, etc. Experts state that antibiotics should only be prescribed AFTER a culture and antibiotic sensitivity test is performed to verify not only the type of bacteria involved but also the most effective antibiotic to treat it with. (Watch a video from AUA 2015 discussing pelvic pain assessment)

#2 – Don’t be fooled! Many antibiotics have an anti-inflammatory effect that can provide temporary relief but  it won’t treat the IC and chronic non bacterial (Type 3) prostatitis. Long term antibiotic use can lead to some dangerous complications.

#3 – The Risk of C-Diff. The use of antibiotics disrupts the normal bacterial flora in the gut which can then lead to an overgrowth of another bacteria, Clostridium difficile. C. Diff can cause a terrible  inflammation of the colon (aka colitis) and is usually manifested in the form of bloody diarrhea. C. diff is responsible for more than 450,000 infections each year and nearly 15,000 deaths. In recent years, it’s also become much more drug resistant and is now labelled a “superbug.” C. diff is highly contagious and can recur leading to life threatening complications. Learn about C-Diff here!  Watch an ABC News Video About It here! 

#4 – Drug Resistant Yeast Infections. Antibiotics also kill the bacteria that normally keep fungus (i.e. candida/yeast) in check thus creating the perfect environment for overgrowth and infection.  The Centers for Disease Control reports that Candida is the most common cause of healthcare-associated bloodstream infections in the United States. Each case results in an additional 3 to 13 days of hospitalization and $6,000 to $29,000 in healthcare costs. Some types of Candida (i.e. Candida glabrata) are becoming increasingly resistant to anti fungal medications.  Approximately 7% of all Candida bloodstream isolates tested at CDC are resistant to fluconazole (aka Diflucan), most of which are Candida glabrata. Learn more here!

#5 – The Critical Health Problem of Antibiotic Resistance. Of the 30 million pounds of antibiotics added into the environment each year, only 20% are used in humans. The rest are used in feed animals who are kept closely confined and in unhealthy environments. To prevent infections, farmers have used millions of pounds of antibiotics to keep them healthy enough for market. The problem, though, is that this creates the perfect setting for bacteria to adapt and change, forming a drug resistant clone. In 2013 & 2014, 634 people became infected with a multiple resistant strain of Salmonella Heidelberg after consuming chicken from Foster Farms. This outbreak caused more severe illness because it was resistant to several strains of antibiotics.  Read the CDC coverage of the outbreak

Just as animals can become a “factory” for antibiotic resistant bacteria, so can you and your gut. Drug resistant infections cause more serious illnesses, deaths from previously treatable illnesses, prolonged recovery, more doctor visits, more invasive and expensive treatments. 

#6 – 5-10% of bladder infections are drug resistant today.  Antibiotic resistancy is now so common that experts report that 5 to 10% resistance rates in common bladder infections at urology clinics. Learn more in this Video from The Doctor’s TV show

#7 – Superbugs Kill Thousands Each Year – An estimated two million people become infected with antibiotic resistant pathogens and at least 23,000 die each year. In 2013, the CDC released a report of the 18 biggest drug resistant threats to public health in the USA. The most urgent are: C. diff, CRE and Neisseria gonnorhea. Read the CDC report here!

#8 – Beaches & Brown Water Can Harbor MRSA – Studies have found multiple resistant staph infections on beaches around the world, causing infections and boils that can lead to amputations and even fatalities. MRSA has been found in ocean water and on beach sand as well as in storm drains and waste water treatment plants. Experts advise to never swim or surf within 72 hours of a  rain storm due to potential pathogens, especially in brown water.  But, we must also consider how these infectious organisms got there. Most likely from our own body waste, as well as waste coming from large animal facilities. So, yes, that ineffective antibiotic you’re considering taking can have long term consequences for others and the environment. Read more about the risk of MRSA and how the surfing community has responded. 

#9 – A Urinary Tract Superbug – One strain of E-coli (H30) has been linked to 1.5 million UTI’s and tens of thousands of deaths. It’s also gained the ability to spread from the urinary tract to the blood, which could lead to sepsis.  Researchers at the University of Washing have also been able to determine that two significant mutations occurred. Ten years ago H30  mutated to become resistant to Cipro (known as H30-R) . Soon after, another occurred (H30-Rx) which is now resistant to several extended spectrum antibiotics including third generation cephalosporins. The good news is that this at least identifies a target that could be used in the development of a vaccine. In the meantime, these infections continue to adapt. (Read about H30 here!)

#10 – Doctors Can No Longer Guarantee That Antibiotics Will Kill Infection. Forty years ago, doctors could virtually guarantee that they could kill most infections in the body with an antibiotic. Today that is no longer possible. Some of bacteria are so resistant that they cannot be killed with any medication. Officials estimate that within a few decades, simple procedures like joint replacement surgery may not be possible because of the lack of effective antibiotics. They also worry that old infections and plagues that were once vanquished with antibiotics could recur and we may not able to treat them.

Antibiotic Stewardship

In March 2015, the White House released the National Action Plan for Combating Antibiotic-Resistant Bacteria. In an interview with WebMD, President Obama said:

“It addresses the problem from multiple angles at once: from stopping the spread of drug resistance right now through the more judicious use of antibiotics, to developing new antibiotics that will save and improve lives in the future, to working with partners worldwide to make sure that while we’re fighting drug resistance here in the United States, it isn’t gaining ground somewhere else in the world. And we’re working to significantly reduce the use of antibiotics in livestock and poultry, too. It’s a good plan. Now we need to carry it out. We can better protect our children and grandchildren from the reemergence of diseases and infections that the world conquered decades ago, but only if we work together, for as long as it takes.”

For the doctors and patients, one key element is to stop using antibiotics inappropriately. A recent survey on WebMD/Medscape found that 95% of health care professionals sometimes prescribe antibiotics when they aren’t sure they’re needed. The national plan provides better information on how doctors can confirm a diagnosis of infection before prescribing but it doesn’t have a specific plan for the patients. It’s really up to us to stop asking for antibiotics “just in case” our flare might be infection. We have to do the work to verify the infection before exposing ourselves and our families to the potential risks that antibiotics present.

How To Differentiate Between an IC Flare Vs. A Bladder Infection

When I first experienced bladder pain as an adult, I must have called my urologist a dozen or more times that first year crying in pain because of a “possible bladder infection” and he, in a desire to be helpful, usually filled those prescriptions EVEN when my urine cultures were negative. In 22 years, I have only had ONE confirmed bladder infection. With the knowledge that IC flares might feel like infection, I now have a  very specific routine.

As soon as I feel a flare or infection beginning, I test my urine with a UTI test strip. If it’s a double positive for leukocytes and nitrates, I call my doctor and request a urinalysis. Sometimes I’ll even take a picture of the test strip with my camera and email it in. If urine tests positive for both nitrates and leukocytes, that suggests active infection. Don’t just ask for antibiotics, make sure that you ask for a urine culture and antibiotic sensitivity test to determine which antibiotic will kill your specific infection. Don’t forget to track the identity of the bacteria and the antibiotic used in your personal medical records kit.

The human body mobilizes leukocytes (white blood cells) when it senses a foreign invader in tissue which could be from bacteria but, in the case of IC, can also be the result of urine leaking into the bladder wall through Hunner’s lesions or glomerulations. So, if I just have a positive leukocyte test but am negative for nitrates, I’ll generally wait 24 hours, do my IC flare protocol then test again.

Of course, if an IC patient has severe or increasing pain, blood in their urine, fever, dizziness or any other unusual or frightening symptoms,  they should call their doctor immediately even if their UTI test strips are negative. Consulting with a medical professional can verify the presence of infection or any other possible conditions, as well as just ease your mind and worries.

Conclusion

In light of the serious risks now posed by the overuse of antibiotics, we each must resist the temptation to ask for them “just in case we have an infection” nor should we self medicate with old antibiotics. We must do the work to verify that we have infection first!