How To Prevent Recurrent Uti In Females – Recurrent urinary tract infections (UTIs) are common in women and are associated with considerable morbidity and health care. Clinical features, diagnostic tests, and aetiological organisms are often similar to those of isolated cases of UTI, although there are additional treatment and prevention strategies that should be considered with recurrent UTIs.
Treatment of complicated urinary tract infections should begin with broad-spectrum antibiotic coverage, with antibiotic coverage adjusted based on culture results.
How To Prevent Recurrent Uti In Females
Recurrent UTIs include relapses (i.e., recurrent symptomatic UTIs with the same organism after adequate treatment) and reinfections (i.e., recurrent UTIs with bacteria previously isolated after treatment with a negative urine culture in between, or recurrent UTIs caused by another bacterial isolate).
Sublingual Mv140 For Prevention Of Recurrent Urinary Tract Infections
One study showed that of college women with a first UTI, 27 percent had at least one culture-confirmed recurrence in the next six months, and 2.7 percent experienced a second recurrence during the same period.
In health care, 53 percent of women over 55 and 36 percent of younger women had a recurrence within a year.
In symptomatic women, predictors of recurrent UTIs include post-coital symptoms, signs or symptoms of nephritis, and sudden resolution of symptoms with antibiotics. The nature and persistence of symptoms between UTI episodes are strong negative predictors of recurrent infection.
Another group of patients who have recurrent UTIs are those with predisposing conditions that put them at greater risk of developing complicated UTIs, with a risk of developing infection (nephritis) or urethritis. The definition of complicated urinary tract infection is imprecise, but the term is generally applied to patients with a predisposition to structural or functional abnormalities in the genital organs.
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Escherichia coli is the predominant uropathogen (80 percent) isolated in acute uncomplicated community-acquired urinary tract infections, followed by Staphylococcus saprophyticus (10 to 15 percent). Enterococcus, Klebsiella, Enterobacter and Proteus species are less common causes.
In uncomplicated recurrent UTIs, reinfection occurs when the original infecting bacteria persist in the stool flora after elimination from the urinary tract, subsequently repopulating the introitus and bladder.
Several host factors appear to predispose otherwise healthy young women to recurrent UTIs. These include local pH and changes in vaginal cervical antibodies; greater adhesion of uropathogenic bacteria to the uroepithelium; and possibly pelvic differences, such as a shorter distance from the urethra to the anus.
Diabetes mellitus, neurologic disease, prolonged institutional residence, and prolonged indwelling urinary indwelling are important predisposing factors for complicated urological disease. In infected patients, organisms that are usually less virulent can cause prominent disease, although infection with E. coli remains the most common organism in nearly all patient populations. Klebsiella and group B streptococcal infections are relatively more common in patients with diabetes, and Pseudomonas infections are relatively more common in patients with chronic urinary catheters. Proteus mirabilis is a common pathogen in patients with lower urinary tract, spinal cord or structural urinary tract injuries.
Pdf) Long Term Antibiotics For Prevention Of Recurrent Urinary Tract Infection In Older Adults: Systematic Review And Meta Analysis Of Randomised Trials
The strongest risk factor for recurrent UTIs in young women is frequency of intercourse. These and other risk factors are listed in Table 1.
There is no proven association between recurrent UTIs and voiding patterns before or after intercourse, frequency of urination, wiping patterns, scrubbing, use of tight underwear, or delayed voiding habits.
A case-control study of postmenopausal women found that mechanical and physiological factors affecting bladder emptying (incontinence, prostatitis, and post-void residual urine) were strongly associated with recurrent urinary tract infections.
Increased post voiding urine volume (ie, greater than approximately 50 mL) is an independent risk factor for recurrent UTIs in postmenopausal women.
Prevention Of Recurrent Urinary Tract Infections In Women
Frequent, urgent, chronic symptoms, pain in the bladder or urethra that is relieved by urination; negative urine culture; ulcers or glomerulations (hemorrhages) detected during cystoscopy
Key steps in the diagnostic evaluation for recurrent UTIs include confirming the presence of bacterial UTI, assessing the patient for risk factors and susceptibility to complicated infection, and identifying the potentially causative organism. Figure 1 shows an algorithm for the evaluation of women with one or more UTI symptoms.
In one systematic review, a combination of symptoms (ie, urinary incontinence, frequency, and no vaginal irritation or discharge) increased the likelihood of a UTI to more than 90 percent,
Which suggests that history alone is often enough to confirm the diagnosis. A decision aid to reduce the unnecessary use of antibiotics in acute cystitis identified three parameters (ie, dysuria, presence of larger than trace leukocytes, and positive nitrites) that were most strongly associated with a positive urine culture.
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Colony forming units per mL may have the best combination of sensitivity and specificity and should be used for diagnosis when culture is necessary.
Although UTIs are often treated empirically in the office, with urine cultures obtained when the diagnosis is unclear or symptoms persist despite antibiotic therapy, the culture may be needed in patients with recurrent UTIs to confirm the diagnosis and guide antibiotic therapy.
It is especially important to review risk factors for complicated UTI in women with UTIs who do not respond to antibiotics, or in those who have recurrent UTIs and no apparent predisposition. In patients with neurologic disease (eg, spinal cord injury) or indwelling urinary catheters, a high level of suspicion for UTI is needed in nonspecific presentations.
There are no specific guidelines or indications for imaging studies in women who have recurrent UTIs but no known underlying medical or organ conditions. Reasonable indications for ultrasound or computed tomography (CT) include recurrent uncomplicated urinary tract infections, persistent hematuria associated with urologic disease, acute nephritis, or evidence of renal failure.
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Recurrent urinary tract infections are common in women with passive voiding, defined as increased external sphincter activity during voluntary voiding in otherwise neurologically healthy patients; this may manifest as urinary frequency, urgency, hesitancy or incomplete emptying of the bladder. There are no guidelines for urologic evaluation in such patients.
Diagnostic evaluation in relation to predisposition (ie, complicated UTI) varies because a urine culture containing antibiotic sensitivity is almost always necessary to guide treatment. It is important to obtain a serum chemistry panel and assess the patient’s general medical condition (eg, hydration, toxicity). In elderly or immunocompromised patients and those with congenital kidney disease, a CT scan or ultrasound is usually required.
Treatment for the initial recurrence of a UTI is the same as for other cases of uncomplicated cystitis. Antibiotic susceptibility of uropathogens in a community should guide treatment decisions. A three-day course of trimethoprim/sulfamethoxazole (TMPSMX; Bactrim, Septra) is the current standard of care, with three days of trimethoprim or a fluoroquinolone (ie, ofloxacin, norfloxacin [Noroxin], or ciprofloxacin [Cipro]) being equally effective.
Because fluoroquinolones are commonly used to treat complicated urological and other non-urinary diseases, resistance to this class of drugs is a concern. Consequently, fluoroquinolones are not recommended as first-line therapy except in communities with high resistance to other drugs.
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With growing concern about E. coli resistance to TMP-SMX (up to 15 to 20 percent in some areas of the United States), nitrofurantoin (Macrodantin) is a safe and generally effective agent if given for seven days.
As the number and frequency of recurrences increases, the treatment strategy is not well defined. Fluoroquinolones and nitrofurantoins become better options as the suspicion of TMP-SMX resistance increases.
In cases of recurrence, a urine culture performed approximately one to two weeks after the end of antibiotic therapy may be considered to confirm clearance.
Patients with recurrent urinary tract infections should be counseled about risk factors such as the use of spermicides, frequent intercourse and new sexual partners, as well as about preventive measures.
Continuous Low Dose Antibiotic Prophylaxis For Adults With Repeated Urinary Tract Infections (antic): A Randomised, Open Label Trial
Antibiotic prophylaxis has been shown to be effective in reducing the risk of recurrent urinary tract infections in women with two episodes of infection in the previous year. Continuous prophylaxis for six to 12 months reduces the incidence of urinary tract infections during the prophylaxis period, with no difference between treatment groups at six months and 12 months after cessation of prophylaxis.
Choice of prophylactic antibiotics should be based on community resistance patterns, side effects, and local cost. Various doses of prophylactic antibiotics have been suggested (Table 4),
The duration of prophylaxis should be guided by the severity of the patient’s symptoms and the physician’s and patient’s preference. Six months of treatment, followed by reinfection after discontinuation of prophylaxis, has been empirically recommended.
Some authorities have recommended longer treatment (two to five years) in patients who continue to have recurrent symptomatic infections.
Urinary Tract Infection
Post-coital prophylaxis may be preferred in women with urinary tract disease associated with temporary intercourse. There was no significant difference in recurrent urinary tract infections when using sequential prophylaxis compared to daily prophylaxis,
Although not strictly a preventative measure, self-initiated treatment is an option for some patients. Women with a history of symptomatic urinary tract infections can be effectively treated with self-initiated antibiotic therapy.
Women may be prescribed a three-day course of antibiotics and instructed to start treatment when symptoms appear. If there is no improvement after 48 hours. the patient should be evaluated clinically.
This strategy should be limited to women who have clearly documented recurrent UTIs and who are motivated, follow medical orders, and have a good relationship with their healthcare provider.
Recurrent Urinary Tract Infection
Behavioral changes can affect the frequency of UTI recurrence. Management of recurrent infections should include modification of known risk factors.
Cranberry juice showed a moderate benefit in reducing the risk of urinary tract infection in women with a history of recurrent infection, based on two well-designed randomized trials. Although there is no clear indication of dosage or duration
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