Abstract
Increasing antimicrobial resistance has stimulated interest in non-antibiotic prophylaxis of recurrent urinary tract infections (UTIs). Well-known steps in the pathogenesis of UTIs are urogenital colonization and adherence of uropathogens to uroepithelial cell receptors. To prevent colonization in postmenopausal women, vaginal, but not oral, estrogens have been shown to restore the vagina lactobacilli flora, reduce vaginal colonization with Enterobacteriaceae, and reduce the number of UTIs compared to placebo. Different lactobacilli strains show different results in the prevention of recurrent UTIs. Intravaginal suppositories with Lactobacillus crispatus in premenopausal women and oral capsules with Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 in postmenopausal women are promising. Ascorbic acid (vitamin C) cannot be recommended for the prevention of UTIs. Cranberries are thought to contain proanthocyanidins that can inhibit adherence of P-fimbriated E. coli to the uroepithelial cell receptors. Cranberry products decreased UTI recurrences about 30%–40% in premenopausal women with recurrent UTIs, but are less effective than low-dose antimicrobial prophylaxis. However, the optimal dose of cranberry product has still to be determined. Initially OM-89, a vaccine with 18 heat-killed E. coli extracts, seemed promising, but this was not confirmed in a recently randomized trial.
Highlights
20%–30% of women with a urinary tract infection (UTI) will have a recurrence.Recurrent urinary tract infections (UTIs) are defined as at least three episodes of a UTI in twelve months, or at least two episodes in six months [1]
Antibiotics are effective in the treatment of UTIs and for low-dose antibiotic prophylaxis but lead to an increase in antibiotic resistance in microorganisms [4]
The susceptibility and pulsed-field gel electrophoresis pattern of E. coli strains isolated from urine in the month before a symptomatic E. coli UTI were similar in about three quarter of patients
Summary
20%–30% of women with a urinary tract infection (UTI) will have a recurrence. Recurrent UTIs are defined as at least three episodes of a UTI in twelve months, or at least two episodes in six months [1]. Recurrent UTIs can be subdivided into relapses and reinfections. A relapse is defined as a UTI caused by the same microorganism after adequate treatment. Reinfection refers to recurrence of a UTI caused by a different microorganism or a recurrent UTI caused by a previously isolated microorganism after treatment and a subsequent negative urine culture [2]. Antibiotics are effective in the treatment of UTIs and for low-dose antibiotic prophylaxis but lead to an increase in antibiotic resistance in microorganisms [4]. Women with recurrent UTIs are increasingly asking their healthcare professionals about the value of taking non-antibiotic products.
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