Prevention of recurrent urinary tract infections: bridging the gap between clinical practice and guidelines in Latin America

Abstract

The branches of the immune system work in concert to defend against pathogens and prevent tissue damage due to excessive inflammation. Uropathogens in general, and uropathogenic Escherichia coli (UPEC) in particular, have evolved a diverse range of virulence mechanisms to avoid detection and destruction by the mucosal immune system of the urinary tract. Research towards a vaccine active against UPEC continues but has yet to be successful. Orally administered immunomodulatory bacterial lysates both stimulate and modulate the immune response in the urinary tract via the integrated mucosal immune system. The 2018 European Association of Urology (EAU) guidelines on treating acute uncomplicated cystitis recommend aiming for rapid resolution of symptoms, reduction of morbidity, and prophylaxis against reinfection. Recommended short-term antibiotic therapy has the advantage of good compliance, low cost, few adverse events, and low impact on bacterial flora. Antibiotic treatment of asymptomatic bacteriuria is only indicated during pregnancy and before invasive interventions. For recurrent infection, prophylaxis using behavioral modification and counseling should be employed first, then nonantibiotic prophylaxis, and, finally, low-dose continuous or postcoital antibiotic prophylaxis. The 2018 EAU guidelines give a strong recommendation for the oral bacterial lysate immunomodulator OM-89. All other nonantibiotic prophylactic strategies require more data, except for topical estrogen for postmenopausal women. For last-resort antibiotic prophylaxis, nitrofurantoin or fosfomycin trometamol are recommended. Guidelines for Latin America are currently being drafted, taking into account the unique ethnicity, availability of medicines, prevalence of antibiotic resistance, and healthcare practices found throughout the region.

Characterization of commercial poultry farms in Mexico: Towards a better understanding of biosecurity practices and antibiotic usage patterns

“…Fosfomycin is used mainly for the treatment of urinary tract infection in humans, with bacterial resistance arising readily in vitro [ 86 ]. In Mexico, fosfomycin represents the last-resort antimicrobial therapeutic alternative [ 87 ]. Therefore, we suggest to add to the Mexican manuals of good husbandry practices, a classification of the antimicrobial classes that are used in poultry aligned with WHO criteria.…”

Nitrofurantoin-induced liver injury: long-term follow-up in two prospective DILI registries

“…The adverse effects described for use of short periods of treatment are usually mild and reversible, mainly gastrointestinal, such as nausea, abdominal discomfort, and headache (Huttner et al 2015 ). However, use during prolonged periods indicated as prophylaxis of recurrent UTI at doses of 50–100 mg/day, or as a postcoital single dose, is common in clinical practice and associated with severe adverse reactions such as pulmonary fibrosis and hepatotoxicity (Ortega Martell et al 2019 ). Due to safety concerns, this has led to contraindications of nitrofurantoin as prophylaxis in some European countries.…”

Independent validation of a predictive nomogram for risk of reinfection in women with recurrent non-complicated urinary tract infections

“…However, there is no high-level evidence to support most behavioral changes in clinical practice. 1–5 Although recurrent UTIs have high direct and indirect costs, there are no tests or questionnaires widely used to assess the risk of recurrence. 1–6…”

“…1–5 Although recurrent UTIs have high direct and indirect costs, there are no tests or questionnaires widely used to assess the risk of recurrence. 1–6…”

“…2 In a primary care setting, 53% of patients older than 55 years reported recurrence of infection after 1 year of observation, whereas in a group of younger patients, the relapse rate was 36%. 3…”