Prevention

Prevention strategies can be initiated for women with recurrent infections and for those with medical comorbidities after complete evaluation of the genitourinary system. Acute infections should always be treated prior to initiating prevention measures.

Cranberry juice or capsules are the most well known preventive agent for UTIs. Cranberry is believed to deter infections by preventing the adherence of fimbrae, thereby assisting in the flushing out of bacteria through voiding. A review of the literature determined that cranberry products significantly reduced the incidence of UTIs over a 12-month period compared with placebo/control.7


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Methenamine hippurate has been studied for its preventive benefits, especially if taken with vitamin C. This combination ensures the acidity of the urine and is believed to form formaldehyde in the urine that can initiate the breakdown of the bacterium protein.

Methenamine with vitamin C is a good option for women with uncomplicated recurring infections and has also been used in women having recurrent UTIs related to incomplete bladder emptying (this use has not been supported in the literature, however).8

In postmenopausal women with recurrent UTIs, treatment with vaginal estrogen is thought to change the vaginal pH, creating a less conducive environment for colonization and ascending infection.4 Vaginal and oral probiotics are thought to have the same benefit through change in the vaginal pH, but the evidence and efficacy are still under investigation.

A number of herbal formulations are available in various forms, but their efficacy and safety has not been studied. Caution patients that herbal products are known to interact with other medications or foods and can have serious side effects.

Summary

UTIs in women are prevalent and often prompt an office visit. Uncomplicated UTIs are easily managed, and treatment is tailored to alleviating symptoms. Urine testing and C&S, although not necessary with first infections, can eventually be important for documentation and treatment strategies if symptoms become recurrent or persistent.

Antibiotic treatment with nitrofurantoin or TMP/SMX will most likely resolve uncomplicated or first-time UTIs. A urine C&S is imperative in cases of recurrent UTI, with treatment of the active infection first followed by the additional initiation of prevention techniques.

The tree acceptable prophylactic treatment options for recurrent UTIs are low dose antibiotics daily for three to six months, self-start antibiotics, and postcoital antibiotics. Follow-up and documentation of recurrent infections combined with ongoing communication and individualized testing and treatment strategies is the best approach to this common medical problem.

Joan E. Zaccardi, DrNP, APRN-BC, is the administrative practice manager of Urogynecology Arts of New Jersey, in East Brunswick.

References

  1. Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and  economic costs. Am J Med. 2002;113 Suppl 1A:5S-13S.
  2. Hanno MP. Lower urinary tract infections in women and pyelonephritis. In: Hanno PM, Malkowicz SB, Wein AJ, Penn Clinical Manual of Urology. Philadelphia, Pa.: Saunders Elsevier; 2007:155-176.
  3. Grimes CL, Lukacz ES. Urinary tract infections. Female Pelvic Med Reconstr Surg. 2011;17:272-278.
  4. Litza JA, Brill JR. Urinary tract infections. Prim Care. 2010;37:491-507.
  5. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 91: Treatment of urinary tract infections in nonpregnant women. Obstet Gynecol. 2008;111:785-794. 
  6. Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52:e103-e120.
  7. Sivick KE, Mobley HL. Waging war against uropathogenic Escherichia coli: winning back the urinary tract. Infect Immun. 2010;78:568-585.
  8. Jepson RG, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2008;1:CD001321.
  9. Lee BS, Bhuta T, Simpson JM, Craig JC. Methenamine hippurate for preventing urinary tract infections. Cochrane Database Syst Rev. 2012;10:CD003265.

All electronic documents accessed January 15, 2013.