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We read with interest the letter by Mr Lance Gravatt in the December 16th 2016 issue of the Journal titled “Urinary alkalisers for cystitis—fact or fiction?”.1 While the fundamental message about the lack of evidence base for routine use of alkalisers for cystitis is reflected well in the letter, there are a few points that we wish to highlight.

Firstly, there are a few inaccuracies in the introductory statement of the letter where our study2 is referenced. The study setting was at Waitakere hospital in West Auckland and not Auckland City Hospital.
New cases of infection were identified over two separate 24 hour periods and not during a single day. There were 81 admissions where any infection was the primary or secondary reason for hospitalisation. Urinary tract infections (UTI) contributed to only 22% (n=18) of these cases. The letter mentions 81 UTIs instead.
The mean length of hospital stay was 5.5 and 12.5 days for medical and rehabilitation patients respectively, and not four days.
Furthermore, it is our view that this reference seems to be somewhat irrelevant to the topic of this letter, which focuses predominantly on outpatient treatment of uncomplicated cystitis.

Secondly, it is worth noting that the activity of certain antibiotics may be affected by changes in urinary pH. Examples include nitrofurantoin (a commonly used antibiotic for treatment of cystitis), which has maximal antibacterial activity in acidic urine, while aminoglycosides and co-trimoxazole demonstrate greater activity against common urinary pathogens with increasing pH.3

Thirdly, we like to draw the reader’s attention to increasing use of restricted antibiotics like pivmecillinam and fosfomycin in both hospital and community settings to treat extended spectrum beta-lactamase producing (ESBL) E.coli and klebsiella pneumoniae bacteria. Such antibiotics are not affected by urinary alkalisers, and are often used when other oral options are limited due to either resistance or drug intolerance issues. A retrospective review4 performed at North Shore Hospital between June 2014 and October 2015 revealed that 70 inpatients with uncomplicated ESBL UTIs (resistant also to nitrofurantoin and norfloxacin) were treated with either fosfomycin (n=42) or pivmecillinam (n=28), after the latter was chosen as the preferred antibiotic in such cases from 2015 onwards.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Bhally H, Department of Medicine and Infectious diseases, Waitemata District Health Board, Auckland; Bondesio K, Department of Pharmacy, Waitemata District Health Board, Auckland; Read K, Department of Medicine and Infectious diseases, Waitemata District Health Board, Auckland.

Acknowledgements

Correspondence

Dr Hasan Bhally, Department of Medicine and Infectious diseases, Waitemata District Health Board, Auckland 0740.

Correspondence Email

hasan.bhally@waitematadhb.govt.nz

Competing Interests

Nil.

  1. Gravatt L. Urinary alkalisers for cystitis—fact or fiction? NZ Med J 2016; 129(1447):96-97.
  2. Read K, Bhally H.‘Real-time’ burden of community and healthcare-related infections in medical and rehabilitation patients in a public hospital in Auckland, New Zealand. NZ Med J 2015; 128(1426):69–74.
  3. Yang L, et al. The influence of urinary pH on antibiotic efficacy against bacterial uropathogens. Urology 2014 Sept 84 (3):731e1–e7.
  4. Bhally H, Read K, Williams N, Park J. Comparison of Pivmecillinam and Fosfomycin for treatment of UTI’s caused by ESBL E.coli and K.pneumoniae. Abstract/poster presented in Australasian Society of Infectious diseases annual scientific meeting, 20th–23rd April 2016, Launceston.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

We read with interest the letter by Mr Lance Gravatt in the December 16th 2016 issue of the Journal titled “Urinary alkalisers for cystitis—fact or fiction?”.1 While the fundamental message about the lack of evidence base for routine use of alkalisers for cystitis is reflected well in the letter, there are a few points that we wish to highlight.

Firstly, there are a few inaccuracies in the introductory statement of the letter where our study2 is referenced. The study setting was at Waitakere hospital in West Auckland and not Auckland City Hospital.
New cases of infection were identified over two separate 24 hour periods and not during a single day. There were 81 admissions where any infection was the primary or secondary reason for hospitalisation. Urinary tract infections (UTI) contributed to only 22% (n=18) of these cases. The letter mentions 81 UTIs instead.
The mean length of hospital stay was 5.5 and 12.5 days for medical and rehabilitation patients respectively, and not four days.
Furthermore, it is our view that this reference seems to be somewhat irrelevant to the topic of this letter, which focuses predominantly on outpatient treatment of uncomplicated cystitis.

Secondly, it is worth noting that the activity of certain antibiotics may be affected by changes in urinary pH. Examples include nitrofurantoin (a commonly used antibiotic for treatment of cystitis), which has maximal antibacterial activity in acidic urine, while aminoglycosides and co-trimoxazole demonstrate greater activity against common urinary pathogens with increasing pH.3

Thirdly, we like to draw the reader’s attention to increasing use of restricted antibiotics like pivmecillinam and fosfomycin in both hospital and community settings to treat extended spectrum beta-lactamase producing (ESBL) E.coli and klebsiella pneumoniae bacteria. Such antibiotics are not affected by urinary alkalisers, and are often used when other oral options are limited due to either resistance or drug intolerance issues. A retrospective review4 performed at North Shore Hospital between June 2014 and October 2015 revealed that 70 inpatients with uncomplicated ESBL UTIs (resistant also to nitrofurantoin and norfloxacin) were treated with either fosfomycin (n=42) or pivmecillinam (n=28), after the latter was chosen as the preferred antibiotic in such cases from 2015 onwards.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Bhally H, Department of Medicine and Infectious diseases, Waitemata District Health Board, Auckland; Bondesio K, Department of Pharmacy, Waitemata District Health Board, Auckland; Read K, Department of Medicine and Infectious diseases, Waitemata District Health Board, Auckland.

Acknowledgements

Correspondence

Dr Hasan Bhally, Department of Medicine and Infectious diseases, Waitemata District Health Board, Auckland 0740.

Correspondence Email

hasan.bhally@waitematadhb.govt.nz

Competing Interests

Nil.

  1. Gravatt L. Urinary alkalisers for cystitis—fact or fiction? NZ Med J 2016; 129(1447):96-97.
  2. Read K, Bhally H.‘Real-time’ burden of community and healthcare-related infections in medical and rehabilitation patients in a public hospital in Auckland, New Zealand. NZ Med J 2015; 128(1426):69–74.
  3. Yang L, et al. The influence of urinary pH on antibiotic efficacy against bacterial uropathogens. Urology 2014 Sept 84 (3):731e1–e7.
  4. Bhally H, Read K, Williams N, Park J. Comparison of Pivmecillinam and Fosfomycin for treatment of UTI’s caused by ESBL E.coli and K.pneumoniae. Abstract/poster presented in Australasian Society of Infectious diseases annual scientific meeting, 20th–23rd April 2016, Launceston.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

We read with interest the letter by Mr Lance Gravatt in the December 16th 2016 issue of the Journal titled “Urinary alkalisers for cystitis—fact or fiction?”.1 While the fundamental message about the lack of evidence base for routine use of alkalisers for cystitis is reflected well in the letter, there are a few points that we wish to highlight.

Firstly, there are a few inaccuracies in the introductory statement of the letter where our study2 is referenced. The study setting was at Waitakere hospital in West Auckland and not Auckland City Hospital.
New cases of infection were identified over two separate 24 hour periods and not during a single day. There were 81 admissions where any infection was the primary or secondary reason for hospitalisation. Urinary tract infections (UTI) contributed to only 22% (n=18) of these cases. The letter mentions 81 UTIs instead.
The mean length of hospital stay was 5.5 and 12.5 days for medical and rehabilitation patients respectively, and not four days.
Furthermore, it is our view that this reference seems to be somewhat irrelevant to the topic of this letter, which focuses predominantly on outpatient treatment of uncomplicated cystitis.

Secondly, it is worth noting that the activity of certain antibiotics may be affected by changes in urinary pH. Examples include nitrofurantoin (a commonly used antibiotic for treatment of cystitis), which has maximal antibacterial activity in acidic urine, while aminoglycosides and co-trimoxazole demonstrate greater activity against common urinary pathogens with increasing pH.3

Thirdly, we like to draw the reader’s attention to increasing use of restricted antibiotics like pivmecillinam and fosfomycin in both hospital and community settings to treat extended spectrum beta-lactamase producing (ESBL) E.coli and klebsiella pneumoniae bacteria. Such antibiotics are not affected by urinary alkalisers, and are often used when other oral options are limited due to either resistance or drug intolerance issues. A retrospective review4 performed at North Shore Hospital between June 2014 and October 2015 revealed that 70 inpatients with uncomplicated ESBL UTIs (resistant also to nitrofurantoin and norfloxacin) were treated with either fosfomycin (n=42) or pivmecillinam (n=28), after the latter was chosen as the preferred antibiotic in such cases from 2015 onwards.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Bhally H, Department of Medicine and Infectious diseases, Waitemata District Health Board, Auckland; Bondesio K, Department of Pharmacy, Waitemata District Health Board, Auckland; Read K, Department of Medicine and Infectious diseases, Waitemata District Health Board, Auckland.

Acknowledgements

Correspondence

Dr Hasan Bhally, Department of Medicine and Infectious diseases, Waitemata District Health Board, Auckland 0740.

Correspondence Email

hasan.bhally@waitematadhb.govt.nz

Competing Interests

Nil.

  1. Gravatt L. Urinary alkalisers for cystitis—fact or fiction? NZ Med J 2016; 129(1447):96-97.
  2. Read K, Bhally H.‘Real-time’ burden of community and healthcare-related infections in medical and rehabilitation patients in a public hospital in Auckland, New Zealand. NZ Med J 2015; 128(1426):69–74.
  3. Yang L, et al. The influence of urinary pH on antibiotic efficacy against bacterial uropathogens. Urology 2014 Sept 84 (3):731e1–e7.
  4. Bhally H, Read K, Williams N, Park J. Comparison of Pivmecillinam and Fosfomycin for treatment of UTI’s caused by ESBL E.coli and K.pneumoniae. Abstract/poster presented in Australasian Society of Infectious diseases annual scientific meeting, 20th–23rd April 2016, Launceston.

Contact diana@nzma.org.nz
for the PDF of this article

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