Trimethoprim / Sulfamethoxazole

Medication, probably the best, fastest route to get better.

It's called Bactrim or Ceptra, and you need to take it for seven to 10 days to eradicate this infection.

Healthy adults may clear the infection on their own, so they might not do anything, no antibiotics, nothing, and they might be able to clear it if they're a healthy young individual with good digestive tract.

Precautions.

But if you

can be like, I've had three E. coli urinary tract infections treated with Bactrim this year, and this paper says this decreases it by 50%, I would like a trial of vaginal estrogen.

Data's good, but collate it.

Doctors, by and large, don't want to see 50 papers of lined, single-spaced data.

One of the problems I think also is that, you know, when we have a new antibiotic like this, but the guidelines that tell us what to do with the treatment of UTIs that are always a little bit behind, you know, the most up-to-date data, the most up-to-date drugs, it's kind of unclear to us in the U.S. exactly where this falls.

At least in terms of how they're using it in Europe, it seems like it's more of a first-line drug, like really being used on that same level as things like nitrofurantoin and Bactrim.

Have you been using this in your practice? Do you have any difficulties in using it? What kind of have you encountered in this new drug?

I have not personally tried to use it yet, primarily surrounding insurance barriers that I would be very interested to hear your experience because I think that we have found that it is not necessarily on formulary around what the insurance options that we have.

Are there any situations that you're concerned about for overuse, like that we haven't really talked about, the patient with the indwelling catheter or the patient with back pain? Are there other situations where you could see this might be an issue and you're worried about it?

One thing that comes to mind is also a little bit of the persistent difficulties with patient care in terms of antibiotic intolerances versus true allergy versus medication interaction for short courses of things.

I think a lot of times we'll find someone maybe has a pan-sensitive bacteria, but they They can't take this for nausea, refusing this because they have stomach pain with this and then all the alerts with their ACE inhibitors and things for Bactrim.

But it kind of takes time to kind of piece through to be like, okay, but like really it's better for you to probably take this nitrofurantoin that you had a little bit of stomach issue with or this Bactrim that is okay, a three-day course, you know, with your ACE inhibitor or something like that.

He remains on HSV prophylaxis.

He remains on Bactrim, so PJP prophylaxis, and he also gets IgG checked.

If it's less than four hundred, we typically replete IVIGs for our patients.

He has since achieved a complete metabolic remission.

Almost all of these patients, well, really all of these patients should be on an anti-shingles medication unless there's a specific contraindication.

We start these patients on Bactrim or potentially Pentamidine for PJP prophylaxis.

And then if they have some other additional immune compromise or reason that they're a compromised host, they may need additional antifungal or antibiotics for prophylactic purposes.

But I think the IVIG can't be stressed enough.

That thermometer that they've kept since the 90s when their, you know, their children were actually children isn't going to cut it.

They need to make sure they've got a new one.

And then I'll go ahead and put these patients on Valtrex and Bactrim before the first dose of their bispecific antibody.

And then I'm checking IgG levels once a month.