paleanne Posted August 7, 2013 Share Posted August 7, 2013 I have a new patient with Myasthenia Gravis and she has tested positive for UTI, culture pending... Any thoughts on antibiotic to use? She says her prior provider was always hesitant to use any antibiotics as patient did not tolerate them well at all. I have not had a patient with this before and I have done some research, just not finding anything helpful. Thanks! Link to comment Share on other sites More sharing options...
d2305 Posted August 7, 2013 Share Posted August 7, 2013 What choice do you have? Link to comment Share on other sites More sharing options...
kkj Posted August 7, 2013 Share Posted August 7, 2013 Avoid AG & macrolides - they can worsen the MG Link to comment Share on other sites More sharing options...
paleanne Posted August 7, 2013 Author Share Posted August 7, 2013 The culture is still pending....She has taken Cipro in the past without problems, but just seems like all antibiotics have potential to exacerbate symptoms. Link to comment Share on other sites More sharing options...
cbrsmurf Posted August 7, 2013 Share Posted August 7, 2013 could also do close f/u like most infections, majority of UTI's will self resolve Link to comment Share on other sites More sharing options...
Moderator ventana Posted August 7, 2013 Moderator Share Posted August 7, 2013 should do Vit C to acidify urine after she is better, and some cranberry supplement as well I tend to go with what the patients tell me in these odd situations.... if you go against the patient and get an adverse outcome.... well they get made at you..... I also tend to say "hang on" and go to some text's or online interaction checkers and see............ in 30 seconds in Up To Date this came up and a whole slew of other info...... ©2013 UpToDate®Export To PowerPoint Print Email Drugs that may unmask or exacerbate myasthenia gravis* [TABLE=class: container] [TR] [TD][TABLE] [TR] [TD=class: subtitle1_single]Anesthetic agents[/TD] [/TR] [TR] [TD]Chloroprocaine[/TD] [/TR] [TR] [TD]Diazepam[/TD] [/TR] [TR] [TD]Ether[/TD] [/TR] [TR] [TD]Halothane[/TD] [/TR] [TR] [TD]Ketamine[/TD] [/TR] [TR] [TD]Lidocaine[/TD] [/TR] [TR] [TD]Neuromuscular blocking agents[/TD] [/TR] [TR] [TD]Propanidid[/TD] [/TR] [TR] [TD]Procaine[/TD] [/TR] [TR] [TD=class: subtitle1_single]Antibiotics[/TD] [/TR] [TR] [TD=class: sublist1_start]Aminoglycosides[/TD] [/TR] [TR] [TD=class: sublist1]Amikacin[/TD] [/TR] [TR] [TD=class: sublist1]Gentamicin[/TD] [/TR] [TR] [TD=class: sublist1]Kanamycin[/TD] [/TR] [TR] [TD=class: sublist1]Neomycin[/TD] [/TR] [TR] [TD=class: sublist1]Netilmicin[/TD] [/TR] [TR] [TD=class: sublist1]Paromomycin[/TD] [/TR] [TR] [TD=class: sublist1]Spectinomycin[/TD] [/TR] [TR] [TD=class: sublist1]Streptomycin[/TD] [/TR] [TR] [TD=class: sublist1]Tobramycin[/TD] [/TR] [TR] [TD=class: sublist1_start]Fluoroquinolones[/TD] [/TR] [TR] [TD=class: sublist1]Ciprofloxacin[/TD] [/TR] [TR] [TD=class: sublist1]Gemifloxacin[/TD] [/TR] [TR] [TD=class: sublist1]Levofloxacin[/TD] [/TR] [TR] [TD=class: sublist1]Moxifloxacin[/TD] [/TR] [TR] [TD=class: sublist1]Norfloxacin[/TD] [/TR] [TR] [TD=class: sublist1]Ofloxacin[/TD] [/TR] [TR] [TD=class: sublist1_start]Others[/TD] [/TR] [TR] [TD=class: sublist1]Ampicillin[/TD] [/TR] [TR] [TD=class: sublist1]Clarithromycin[/TD] [/TR] [TR] [TD=class: sublist1]Clindamycin[/TD] [/TR] [TR] [TD=class: sublist1]Colistin[/TD] [/TR] [TR] [TD=class: sublist1]Erythromycin[/TD] [/TR] [TR] [TD=class: sublist1]Lincomycin[/TD] [/TR] [TR] [TD=class: sublist1]Quinine[/TD] [/TR] [TR] [TD=class: sublist1]Telithromycin[/TD] [/TR] [TR] [TD=class: sublist1]Tetracyclines[/TD] [/TR] [TR] [TD=class: subtitle1_single]Anticonvulsants[/TD] [/TR] [TR] [TD]Gabapentin[/TD] [/TR] [TR] [TD]Phenytoin[/TD] [/TR] [TR] [TD]Trimethadione[/TD] [/TR] [TR] [TD=class: subtitle1_single]Antipsychotics[/TD] [/TR] [TR] [TD]Chlorpromazine[/TD] [/TR] [TR] [TD]Lithium[/TD] [/TR] [TR] [TD]Phenothiazines[/TD] [/TR] [/TABLE] [/TD] [TD][TABLE] [TR] [TD=class: subtitle1_single]Antirheumatic drugs[/TD] [/TR] [TR] [TD]Chloroquine[/TD] [/TR] [TR] [TD]Penicillamine[/TD] [/TR] [TR] [TD=class: subtitle1_single]Cardiovascular drugs[/TD] [/TR] [TR] [TD]Beta blockers[/TD] [/TR] [TR] [TD]Bretylium[/TD] [/TR] [TR] [TD]Procainamide[/TD] [/TR] [TR] [TD]Propafenone[/TD] [/TR] [TR] [TD]Quinidine[/TD] [/TR] [TR] [TD]Verapamil and calcium channel blockers[/TD] [/TR] [TR] [TD=class: subtitle1_single]Glucocorticoids[/TD] [/TR] [TR] [TD]Corticotropin[/TD] [/TR] [TR] [TD]Methylprednisolone[/TD] [/TR] [TR] [TD]Prednisone[/TD] [/TR] [TR] [TD=class: subtitle1_single]Neuromuscular blockers and muscle relaxants[/TD] [/TR] [TR] [TD]Botulinum toxin[/TD] [/TR] [TR] [TD]Magnesium sulfate and magnesium salts[/TD] [/TR] [TR] [TD]Methocarbamol[/TD] [/TR] [TR] [TD=class: subtitle1_single]Ophthalmologic drugs[/TD] [/TR] [TR] [TD]Betaxolol[/TD] [/TR] [TR] [TD]Echothiophate[/TD] [/TR] [TR] [TD]Timolol[/TD] [/TR] [TR] [TD]Tropicamide[/TD] [/TR] [TR] [TD]Proparacaine[/TD] [/TR] [TR] [TD=class: subtitle1_single]Other drugs[/TD] [/TR] [TR] [TD]Anticholinergics[/TD] [/TR] [TR] [TD]Carnitine[/TD] [/TR] [TR] [TD]Cholinesterase inhibitors[/TD] [/TR] [TR] [TD]Deferoxamine[/TD] [/TR] [TR] [TD]Diuretics[/TD] [/TR] [TR] [TD]Emetine (Ipecac syrup)[/TD] [/TR] [TR] [TD]Interferon alpha[/TD] [/TR] [TR] [TD]Iodinated contrast agents[/TD] [/TR] [TR] [TD]Narcotics[/TD] [/TR] [TR] [TD]Oral contraceptives[/TD] [/TR] [TR] [TD]Oxytocin[/TD] [/TR] [TR] [TD]Ritonavir and antiretroviral protease inhibitors[/TD] [/TR] [TR] [TD]Statins[/TD] [/TR] [TR] [TD]Thyroxine[/TD] [/TR] [/TABLE] [/TD] [/TR] [/TABLE] * Drugs listed here should be used with caution in patients with myasthenia gravis. Aminoglycosides should be used only if absolutely necessary with close monitoring. Please refer to the text for further information. Link to comment Share on other sites More sharing options...
cbrsmurf Posted August 7, 2013 Share Posted August 7, 2013 wow, that's a long list in regards to cranberry juice, the evidence is very weak that they protect against recurrent UTI's never heard about Vit C to be honest.. any studies? Link to comment Share on other sites More sharing options...
d2305 Posted August 7, 2013 Share Posted August 7, 2013 Septra ds it is. Link to comment Share on other sites More sharing options...
Acebecker Posted August 8, 2013 Share Posted August 8, 2013 Don't see Macrobid on that list; not the best alternative if Pt is >65 or if there is urine stasis, but not a bad option if it's all you've got - just need a longer course. There has been some research hitting the press about probiotics in the treatment of UTIs as well as the prevention of UTIs. One fairly large study I read (I'll have to look it up) showed comparable effects between macrodantin 100mg q HS and 100,000 cfus of probiotics in UTI prophylaxis. I don't recall what the studies showed regarding treatment regimens, but I know it's being studied. Link to comment Share on other sites More sharing options...
fuma102 Posted August 8, 2013 Share Posted August 8, 2013 Fosfomycin. bactrim. zyvox. Link to comment Share on other sites More sharing options...
Acebecker Posted August 8, 2013 Share Posted August 8, 2013 Fosfomycin is apparently very expensive; repatented, I guess. Link to comment Share on other sites More sharing options...
jwells78 Posted August 8, 2013 Share Posted August 8, 2013 MG exacerbation vs. Urosepsis? Hmmm. What WON'T cause an exacerbation? That list is pretty long... Cipro in the past without issue = SOUNDS GOOD TO ME. Otherwise, Cephalexin? Septra? Link to comment Share on other sites More sharing options...
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