Repeated urine infections

[Greentime101]

My elderly mother has had 2nd urine infections in 2 months both have caused her to fall so that was 2 ambulances, she broke a bone the first time so that was 3 weeks in hospital etc etc

This time we are on day 2 of trying to get the requested antibiotics from the GP, yesterday she spent almost 2 hours on the phone for the Dr to prescribe her “new” ones I did the 1.5 hour round trip to collect from chemist and take to mum who then vomitted them all back up - this happens with most antibiotics hence her asking for specific ones. So today another hour on the home & her neighbour has done the 45 min round trip to the chemist

The only thing I can think to break this cycle of doom is to purchase urine testing strips from Amazon & she tests every day - if she gets positive she starts antibiotics she has already been given? Any other bright ideas? Apparently pharmacists can’t dole out antibiotics to over 70s what a shame.

Might be worth trying a preventive dose of D-mannose. And anything that would encourage her to drink more - one of those beeping bottles, nice squash?

Vita biotic ultra cranberry tablets, 1 a day.

This is really common in elderly ladies - I think you should try and get her on low dose vaginal oestrogen pessaries to help prevent it (very very low risk but could be life saving - my own mother had encephalitis caused by a urine infection).

Yes I should have added its 100% caused by not drinking enough water and then not emptying bladder frequently enough (mobility issues) she denies both & is on so much medication I dare not add anything else - I think it might just be an impossible situation

Even when you are very elderly, vaginal oestrogen can help prevent UTIs.

The easiest for your mum would be an Estring as it's inserted and left, however there are ongoing issues with stock.

Now to convince my own mother of this - impossible!

What was successful with my DM was that she did have symptoms of a UTI but had been ignoring them until she had full blown sepsis. She now alerts at the first hint of an issue and there have been no crises since.

Cranberry powder sprinkled in her food or drinks? Apparently there is some compound in cranberries that help stop bacteria sticking to the bladder walls, but it won't cure an existing UTI

Cranberry sadly is a myth.

Again a myth my mother fully buys in to and the house is heaving with cranberry juice.

Taking aniline this can cause resistance, she needs the right one for the bacteria although some doctors to prescribe a continuous daily dose. Ask the pharmacy to deliver medication to her home. There might be a community pharmacist or medicines management nurse in the community who might help. If she's not drinking enough, has mobility problems I would ask for a continence referral.

Agree about the vaginal oestrogen helping.

@AnnaMagnani re cranberry being a myth - is that the same for cranberry tablets too ?

My aunt was a gp before she retired - she says to get potassium citrate from the chemist to add to water at the first hint of an infection, although I want to caveat this by saying that she told me to tell the pharmacist it was for me not my mum as they don’t like to give it to the elderly, but apparently it’s harmless and she had it all the time at med school 🙄 - maybe one to talk to a pharmacist about as a last resort!

I think I will ask her GP (I have medical POA) to prescribe something preventative as it will better received that way, rather the just another one of my “suggestions”
No joined up thinking - she has cost the NHS fortunes & I’m the only one looking for prevention.

To answer another point there is a prescription delivery service but only once a week so in all these urgent situations. It’s useless - I honestly do not know how elderly people cope alone

We bought the strips from Amazon and tested regularly. Luckily the local GP practice had 2x nurse practitioners specialising in the elderly so at the first sign of trouble the carer would phone and get a prescription.

The carer made 3 calls a day and tried to get as much fluid into my mum as possible. My mum lived with dementia for 10 years so each morning it was "look what I found in the supermarket. I think it is new would you like to try it." and my mum would try it and like it so have some more.

There were probably 3 hospital admissions linked with UTIs over that decade which was not a bad outcome.

My dad had dementia and we lost him 18 months ago - now mum has taken up where he left off - honestly the level of care required just to drink water, never mind life’s other complexities I don’t think anyone realises the stress of it unless they have experience

A separate point but I'd be thinking how she is going to manage going forward practically if you're some distance away. She will only get frailer. These problems will become commonplace.
Is her house manageable, does she have carers etc? What are her plans for coping? Maybe the rainy day is here.

Well if she could get the attendance allowance she deserves then we can put a package of care in place - I am just about to take the DWP to a tribunal/appeal over this - she has been treated appallingly

Is she washing with a flannel? We were told by continence folk that this is a key cause of UTIs.

The results using cranberry juice were mixed, some studies showing benefits and some not at all. Studies with cranberries supplements were more successful. The juice contains a lot of sugar to make the bitter cranberry more palatable and salt which isn't ideal - also there tends to be a big drop off in studies as subjects struggle with taste and bitterness. Shouldn't be taken with warfarin. So it may help some.

Quadriplegic family member and another elderly male one (who had repeated UTI's) use them and say they are beneficial - but who knows? Anecdotally a lot of medical professionals I have come across swear by them. But, as I said, not taken as a cure but as a preventative.

What are the strips being referred to please? Can one self diagnose a UTI?

I think they mean the urine strips which COULD show up protein, blood and leukocyte which COULD indicate a uti but they cannot be used to determine the bacteria, if an infection is present or if an antibiotics should be prescribed, for that you need a specimen.

Despite this they were useful.

The carer would notice my mother seemed off colour, and would quickly test. If positive she would phone the specialist nurse practitioner over the phone. Given my mother was in her late 80s and with a history, the NP seemed happy to prescribe in advance of the urine test results. That way things got nipped in the bud.

Never did the slightest good for me. Had a UTI on holiday once, this was all the pharmacist would offer, and it was utter hell all Sunday till I could get home and to a GP.

Sorry to hear that, the way she goes on about it you’d have thought it was a magic potion!

I used to always have a packet of antibiotics in case, and took it once the symptoms were well established (ie pain and unable to move more than 5mins from the loo). If you can establish in her notes the antibiotics she needs, maybe you could persuade them to do that? Then it would be a routine replacement, not an emergency one.

I suspect she’s one of the lucky 50% who doesn’t get UTIs