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I have been interested in Professor Malone-Lee's work on UTI symptoms because I was at the receiving end of requests to prescribe long term high dose antibiotics from patients he had seen. His empathy and concern for people who have chronic, troublesome and sometimes, disabling symptoms was undoubted.
However, I remain sceptical of the theory of long term infection of the urinary tract. That some infections are missed by routine microbiology tests is accepted. Treating empirically in the absence of proven infection is justifiable. However, the concept of using high dose daily antibiotics for many months troubles me greatly.
Firstly, the concept of infection that can only be detected on specialised tests and then needs months, sometimes over a year, of treatment seems biologically implausible. Secondly, the advocated doses and lengths of treatment run a coach and horses through any antibiotic stewardship policy. And, thirdly, quinolone antibiotics, specifically ciprofloxacin, have been recommended and prescribed, as well as those mentioned in the obituary. These are linked to damage to collagen structures such as tendons and heart valves and simply cannot be justified in this scenario.
Yours faithfully
Harpreet Singh Arshi
Competing interests:
No competing interests
25 July 2022
Harpreet S. Arshi
GP and Medical Officer
St Thomas Medical Group, Exeter and University of Exeter
Dangers of long term antibiotics for presumed UTI
Dear Editor
I have been interested in Professor Malone-Lee's work on UTI symptoms because I was at the receiving end of requests to prescribe long term high dose antibiotics from patients he had seen. His empathy and concern for people who have chronic, troublesome and sometimes, disabling symptoms was undoubted.
However, I remain sceptical of the theory of long term infection of the urinary tract. That some infections are missed by routine microbiology tests is accepted. Treating empirically in the absence of proven infection is justifiable. However, the concept of using high dose daily antibiotics for many months troubles me greatly.
Firstly, the concept of infection that can only be detected on specialised tests and then needs months, sometimes over a year, of treatment seems biologically implausible. Secondly, the advocated doses and lengths of treatment run a coach and horses through any antibiotic stewardship policy. And, thirdly, quinolone antibiotics, specifically ciprofloxacin, have been recommended and prescribed, as well as those mentioned in the obituary. These are linked to damage to collagen structures such as tendons and heart valves and simply cannot be justified in this scenario.
Yours faithfully
Harpreet Singh Arshi
Competing interests: No competing interests