Treatment Of Urinary Tract Infections In Women Research Articles

Pharmacokinetic/Pharmacodynamic Analysis of Oral Calcium Fosfomycin: Are Urine Levels Sufficient to Ensure Efficacy for Urinary Tract Infections?

Urinary tract infections (UTIs) are extremely common and a major driver for the use of antimicrobials. Calcium fosfomycin is an old antibiotic indicated for the treatment of UTIs; however, data about its urine pharmacokinetic profile are scarce. In this work, we have evaluated the pharmacokinetics of fosfomycin from urine concentrations after oral administration of calcium fosfomycin to healthy women. Moreover, we have assessed, by pharmacokinetic/pharmacodynamic (PK/PD) analysis and Monte Carlo simulations, its effectiveness considering the susceptibility profile of Escherichia coli, the main pathogen involved in UTIs. The accumulated fraction of fosfomycin excreted in urine was around 18%, consistent with its low oral bioavailability and its almost exclusively renal clearance by glomerular filtration as unchanged drug. PK/PD breakpoints resulted to be 8, 16, and 32 mg/L for a single dose of 500 mg, a single dose of 1000 mg, and 1000 mg q8h for 3 days, respectively. For empiric treatment, the estimated probability of treatment success was very high (>95%) with the three dose regimens, considering the susceptibility profile of E. coli reported by EUCAST. Our results show that oral calcium fosfomycin at a dose level of 1000 mg every 8 h provides urine concentrations sufficient to ensure efficacy for the treatment of UTIs in women.

Імплементація урологічних настанов із лікування інфекцій сечових шляхів у належну практику України

Настанови Європейської асоціації урологів (EAU,2013–2015) з лікування інфекцій сечових шляхів сьогодні, ймовірно, є пріоритетним документом у визначенні діагностичних підходів і лікуванні інфекцій сечових шляхів (ІСШ). В статті наведено ретроспективний аналіз лікування неускладнених ІСШ у жінок, проведений за результатами лікування препаратом Макмірор, фурамагом і нітрофурантоїном у період 2013–2015 рр.

Efficacy of food supplement Acidif plus® in the treatment of uncomplicated UTIs in women: a pilot observational study.

Urinary tract infections (UTIs) are among the most common bacterial infection diagnosed in women. The standard therapy is represented by short course of anti-microbial treatment to eradicate causative pathogens. However, due to antibiotic treatment, normal microbiota of the gastrointestinal tract is at risk of depletion and prolonged use of antibiotics can lead to the development of resistant strains. The aim of this pilot study was to assess the efficacy of Acidif plus®, a novel preparation containing L-Methionine, Boswellia serrata and Hibiscus sabdariffa, in the treatment of UTIs in women, in comparison with standard antibiotic treatment with fosfomycin. We performed a pilot clinical study with 88 patients with uncomplicated UTIs treated in ambulatory care clinics. The subjects recruited in the study were divided into two groups: the treatment group included 57 patients with both symptomatic and asymptomatic uncomplicated, bacteriuria-positive UTIs, who were treated by oral administration of Acidif plus® two tablets per day (1 tablet in the morning and 1 tablet in the evening) for 7 days. The control group included 31 patients with both symptomatic and asymptomatic bacteriuria-positive uncomplicated UTIs, treated with fosfomycin for two consecutive days. Clinical improvement of symptoms and urine bacteriuria were evaluated as treatment outcomes. More than 50% of Acidif plus® treated patients were free of symptoms of UTIs at the end of the treatment regime. In addition, Acidif plus® treatment was effective in eliminating the bacterial infection in the post-treatment urine cultures in more than 85% of the patients. In this study Acidif plus® treatment in patients with uncomplicated UTIs was found to be non-inferior to the standard antibiotic therapy. In acute setting, Acidif plus® was shown to be even more effective in alleviating the symptoms than fosfomycin and in eliminating bacteria in urine cultures. It is therefore possible to propose Acidif plus® as a potential alternative option to reduce the problem of multi-drug resistance in urinary infections.

Risk of recurrent acute lower urinary tract infections and prescription pattern of antibiotics in women with and without diabetes in primary care

Women with diabetes have an increased risk of urinary tract infections (UTIs), especially recurrences. Aim. To investigate diabetes characteristics associated with the risk of recurrent lower UTIs and the antibiotic prescription pattern. In an exploratory retrospective study involving 7063 women aged>or=30 years, we studied the incidence of recurrent UTI (relapses and reinfection) in women with (n=340) and without diabetes (n=6618). Multivariable logistic regression and multilevel multinomial logistic analyses were used to determine the adjusted associations between diabetes characteristics and recurrent UTI [odds ratio (OR); 95% confidence interval (CI)] and the influence of diabetes on the pattern of antibiotic prescriptions for UTI, respectively. Relapses and reinfections were reported in 7.1% and 15.9% of women with diabetes versus 2.0% and 4.1% of women without diabetes. There was an independent higher risk of recurrent UTI in women with diabetes compared with women without diabetes (OR 2.0; 95% CI 1.4-2.9). Women taking oral blood glucose-lowering medication (OR 2.1; 95% CI 1.2-3.5) or insulin (OR 3.0; 95% CI 1.7-5.1) or who had had diabetes for >or=5 years (OR 2.9; 95% CI 1.9-4.4) or who had retinopathy (OR 4.1; 95% CI 1.9-9.1) were at risk of recurrent UTI. The pattern of antibiotic prescriptions for UTI was not influenced by diabetes. Women with diabetes>or=5 years or with glucose-lowering medication or with retinopathy have an increased risk of recurrent UTI. Diabetes itself does not seem to influence the antibiotic prescription pattern. Research focusing on effective antibiotic treatment of UTI in women at risk of recurrence is needed and may help limit the development of antibiotic resistance.

UROLOGIC DISEASES IN AMERICA PROJECT: TRENDS IN RESOURCE USE FOR URINARY TRACT INFECTIONS IN WOMEN

Urinary tract infection (UTI) is one of the most common clinical diagnoses in women. In this study we examined epidemiological, economic and health care use trends for UTI in women in the United States. The analytical methods used to generate these results have been described previously. The lifetime risk for UTI in women is high (greater than 50%). Between 1988 and 1994 the overall lifetime prevalence of UTI was estimated to be 53,067/100,000 women. Prescribing patterns demonstrated an increase in the trend toward using fluoroquinolones as first line therapy for UTI, which was associated with increased costs. Composite data revealed that overall expenditures for the treatment of UTIs in women in the United States, excluding spending on outpatient prescriptions, were approximately 2.47 billion dollars in 2000. Diagnosis and treatment of UTI in women is performed in various clinical settings. Inpatient hospitalization for UTI care has generally decreased in younger women but increased in elderly women. There has been a sharp increase in emergency room use by younger women, which may reflect disparities in access to health insurance or primary care providers. Most outpatient care of women with UTIs is performed in physician offices. Analysis of health care use and economic data on UTIs in women revealed various interesting trends. These findings will help shape understanding of UTI treatment in relation to other urological disorders in women. The results raise various important future research questions.

Urinary tract infection in women--physician's preferences for treatment and adherence to guidelines: a national drug utilization study in a managed care setting.

The treatment of urinary tract infection (UTI), the most common bacterial infection in most Western countries, is a global clinical and economic issue. Trimethoprim-sulfamethoxazole (TMP-SMX) and nitrofurantoin are the two drugs currently recommended in clinical guidelines in Israel for uncomplicated UTI in women. This study evaluates physician preferences for treatment and adherence to guidelines. Data were derived from the electronic records of Leumit Health Fund, one of four health management organizations in Israel. Non-pregnant women aged 18-75 years with a diagnosis of acute cystitis or UTI without risk factors for complicated UTI who were empirically treated with antibiotics from January 2001 to June 2002 were identified. The final sample comprised 7738 physician-patient encounters. Physician prescription behavior was analyzed by evaluating the proportion of treatments with each individual drug. A binary regression model was implemented to identify factors associated with suboptimal adherence to the guidelines. TMP-SMX was the most frequently prescribed drug (25.81%), followed by nitrofurantoin (14.71%), for a 40.52% rate of adherence to the guidelines [95% confidence interval (CI)=39.42, 41.61]. Drugs from the fluoroquinolone family were prescribed in 22.82% of cases. Prescription behavior was also influenced by non-clinical, non-pharmacological factors, such as physician specialty, geographic setting and patient age. The majority of cases of UTI in the present study were not treated according to the current guidelines. Fluoroquinolones, though not recommended and relatively costly, were prescribed extensively. These results highlight the necessity for a remedial education program within the health care system designed to improve adherence to the guidelines for the treatment of UTI in women. As this issue is of global importance, this evaluation may serve as a model for similar studies in other settings or countries.