Nonantibiotic Prophylaxis for Recurrent Urinary Tract Infections: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Beerepoot, M.A.J.; Geerlings, Suzanne E.; Haarst, Ernst P. van; Charante, N. Mensing van; Riet, Gerben ter

doi:10.1016/j.juro.2013.04.142

Cited by 176 publications

(135 citation statements)

References 40 publications

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“…However, there is either insufficient evidence or availability in Canada to recommend their use at this time. 1,7,8 What antibiotic options are available to prevent further UTIs? In women who tend to have UTIs temporally related to sexual activity, postcoital prophylaxis with a single dose of antibiotic has been shown in a randomized clinical trial to reduce repeat UTIs.…”

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confidence: 99%

Frequent urinary tract infections in a premenopausal woman

Welk¹,

Hickling²

2016

CMAJ

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A 35-year-old healthy premenopausal woman presented with a 24-hour history of worsening dysuria and urinary frequency. She had no associated flank pain or costovertebral angle tenderness to suggest pyelonephritis. Urine dipstick testing was positive for leukocyte esterase and nitrite. The patient reported two documented urinary tract infections (UTIs) in the past eight months. Her previous urine cultures had grown pan-sensitive Escherichia coli, and her symptoms had resolved promptly with oral antibiotics. What diagnoses should be considered in this patient?The most likely diagnosis is recurrent UTIs. These recurrent infections are important given their high prevalence and their negative effect on quality of life.1 Other potential diagnoses to consider include sexually transmitted infection, bladder pain syndrome, pelvic floor dysfunction, overactive bladder and vaginitis (Box 1). 2 Does this patient need further investigations?Recurrent UTIs are common: 20%-50% of women will experience at least one UTI recurrence after their index infection and a subset (about 5%) will have multiple recurrences, often within the first three months after the index infection.3 For most of these women, further evaluation is not necessary. In a case series of young women with frequent UTIs, cystoscopy and renal or pelvic imaging did not reveal any important abnormalities that influenced patient management. 4Further testing should be limited to women with atypical features or with multiple episodes of pyelonephritis. Complicating factors that may suggest the patient should be referred to a specialist include prior urologic or pelvic floor surgery, history of renal stone disease, genitourinary or neurologic abnormalities, substantial urinary symptoms (e.g., severe urinary urgency or frequency, or urinary-related pain), radiation to the pelvis, or inadequate response to antibiotics. 4What lifestyle changes should be recommended? Doctors have long recommended a "common sense" collection of suggestions for avoiding UTIs, such as good perineal hygiene, natural underwear material, postcoital voiding, and improved fluid intake and voiding habits. However, when these factors were evaluated in a large case-control study, these conservative measures Decisions

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confidence: 99%

Frequent urinary tract infections in a premenopausal woman

Welk¹,

Hickling²

2016

CMAJ

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“…Increasing antimicrobial resistance has stimulated interest in non-antibiotic prophylaxis of recurrent UTI. Several randomized controlled trials confirm the effectiveness of the oral immunostimulant OM-89, vaginal estrogens and proanthocyanidins [16]. Further studies are needed to determine whether RGHP is suitable for preventing the recurrence of UTI.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of a Medical Device versus Placebo in the Early Treatment of Patients with Symptoms of Urinary Tract Infection: A Randomized Controlled Trial

A¹,

Alexe²

2016

Clin Microbiol

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“…8 Immunoactive prophylaxis of recurrent UTIs with lyophilized lysate of E. coli (OM-89) has been shown to be more effective than placebo in randomized trials with a good safety profile. 11,12 It is recommended for RUTI prevention by the 2015 European Association of Urology guidelines and the 2015 Febrasgo Manual of Urogynecology. 6,7 The accessibility of clinically proven probiotics for UTI prophylaxis is currently not universal.…”

Section: Non-antimicrobial Methods Should Be Considered For Ruti Prevmentioning

confidence: 99%

Recurrent Urinary Tract Infection in the Gynecologic Practice: Time for Reviewing Concepts and Management

Filho

Contreras

Haddad

2016

Rev Bras Ginecol Obstet

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Nonantibiotic Prophylaxis for Recurrent Urinary Tract Infections: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cited by 176 publications

References 40 publications

Frequent urinary tract infections in a premenopausal woman

Frequent urinary tract infections in a premenopausal woman

Efficacy and Safety of a Medical Device versus Placebo in the Early Treatment of Patients with Symptoms of Urinary Tract Infection: A Randomized Controlled Trial

Recurrent Urinary Tract Infection in the Gynecologic Practice: Time for Reviewing Concepts and Management

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