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How can urinary sepsis be treated?

Q: My 66 years old father was treated for cystitis 3 months back. It started with fever and a fall in blood pressure, which was later attributed to urinary tract infection (UTI), which caused oedema in the gall bladder also. Grade I prostatomegaly was diagnosed. He was treated with Piperacillin and after getting discharged; he was advised to take a course of Ceftum. The prostate specific antigen (PSA) was found to be 37.6. But after 10 days of getting discharged from the hospital, PSA was again tested and was found to be 17 and again after 25 days it was 3.79. Though my father recovered well but was complaining of tiredness and pain in his legs, so urine culture was done, which revealed a count of 10.3. The doctor prescribed Minipress XL 2.5 mg and Dutas once daily. Before getting hospitalised, my father was taking Aten 50. The doctor told us to discontinue Aten 50 as Minipress XL would suffice. He said that the urine culture showed no significant count and advised to take Niftran as my father was complaining of pain in his thighs. But after taking Niftran for 2 days, he was complaining of gas problem and hence he discontinued it. But now, immediately after getting up early in the morning, he feels severe hunger and weakness and unless he takes food in the form of curd rice or a meal, he is unable to stand the hunger even for 1-2 hours. Also he says that if he does not take food every 4-5 hours, he feels weak. Prior to hospitalisation he used to play badminton regularly and did not have any such problem. Please advise.

A:Your father had an episode of urinary sepsis with fever, urinary symptoms, acute rise in PSA and drop in blood pressure. Apparently the serious sepsis was attributed to bladder outlet obstruction (BOO), and it has been decided to treat the BOO medically. Medical treatment of BOO usually consists of a combination of prescribed drugs, an alpha-blockers (like Minipress XL) and a 5 alpha reductase inhibitor (like Dutas). The observations in current scenario are:

  1. It is recommended that such serious sepsis, if attributed to BOO, should be treated surgically as medical treatment is not as effective.
  2. Alpha blockers are primary drugs for BOOs medical treatment, while 5 alpha reductase inhibitors take a long time to be effective. The current recommended dosage of alpha-blockers are therapeutically suboptimal. Though such small dose may be effective for controlling blood pressure the dosage have to be much higher to be effective at bladder neck.
  3. It would be advisable to continue with low dose antibiotic coverage with Furdentin, as advised.
  4. Though alpha blockers may cause weakness, he needs to be investigated for diabetes (blood sugars) and other medical conditions, which my be causing the weakness and hunger he is experiencing.

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