In Australia, we treat UTIs with the following medicines:
- Amoxycillin with clavulanic acid
- Fosfomycin trometamol (NEW)
- Hexamine hippurate (used prophylactically).
Patients with an UTI often have painful and burning sensation when they urinate. We can help treat this symptomatically and recommend a product with sodium bicarbonate (e.g. Ural) to alkalinise their urine.
From the medicines listed above, which one may have an issue with sodium bicarbonate? Hint: it’s more than half.
- Nitrofurantoin – “alkalinising drugs increase the excretion rate and may diminish the effect”.
- Norfloxacin – “concomitant use of urinary alkalinisers and fluoroquinolones is not recommended due to an increased risk of crystalluria.”
- Fosfomycin trometamol – “Concomitant usage with urinary alkalinisers is not recommended… (it) is most bactericidal at typical urinary pH.”
- Hexamine hippurate (used prophylactically) – “Sodium bicarbonate alkalinises the urine preventing formation of formaldehyde; reduces antibacterial effect of hexamine.”
Health professionals must KNOW these medicines may have potential issues with sodium bicarbonate; as it is only natural for patients to seek symptomatic relief of their painful urination. When prescribing or counselling on these medicines, warn the patients NOT to take urinary alkalinisers concurrently (or in some cases space them apart).
This is especially important in pharmacy, where patients may request sodium bicarbonate products. These patients most likely have a UTI and are taking a medicine to treat it. Will you have time, to check if it’s one that may have an issue?
Originally posted on Memorise Medicine Instagram.
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