Sunday, July 7, 2024

Antibiotic Suppression For Recurrent Uti

Why Your Uti Test Results May Be Negative Despite Symptoms

#22954 Outpatient electrofulguration for antibiotic-recalcitrant recurrent urinary tract infecti…

Now that weve explained a bit more about why your recurrent UTIs may in fact be one, embedded UTI, lets take a look at UTI testing.

Have you ever had UTI symptoms, felt quite sure that you have a UTI, but your test has come back negative? This is incredibly common – not to mention frustrating. And your hunch is likely right: If you are experiencing symptoms, its very possible you have a UTI.

There are a few reasons why your UTI test result might be negative:

  • Urine is not sterile

    It has been found that the bladder has its own unique microbiome with hundreds of different bacteria. So a urine sample that may be dismissed as being contaminated with foreign bacteria, may in fact contain bacteria that are an important part of the puzzle.

  • The pathogens causing your symptoms may not be in your sample

    Standard UTI test methods focus on free-floating pathogens. Embedded biofilm infections attached to the bladder wall are not free-floating and less likely to pass out via your urine sample. Its also possible your urine sample is too diluted, e.g. due to over-hydrating.

  • UTIs can be caused by multiple pathogens

    As mentioned earlier, a UTI can be caused by multiple infection-causing pathogens. The 1950s test only looks for a single pathogen. If more than one are found, it may presume the urine sample was contaminated.

  • Access To Data And Data Security

    Caldicott approval for use, transfer and storage of participant identifiable information will be obtained at each site.

    All research data will be kept in accordance with Newcastle Universitys information security policy . Newcastle University maintains a series of regular backups and off-site mirror servers to ensure continuity and disaster recovery.

    Elseviers MACRO database is an electronic data capture system which complies with the requirements of regulatory bodies and maintains an audit trail of any changes to the data. All data stored in MACRO benefit from Elseviers hosting service in collaboration with Rackspace which features redundancy and backup measures in case of disaster. Users have password-limited access to the MACRO database, which restrict access to their own particular role and site.

    Why This Research Is Needed Now

    A recent meta-analysis reviewed the evidence for non-antibiotic treatments as prophylaxis against rUTI but the results were disappointing, mainly due to paucity of evidence . One of the conclusions in this report was that Although sometimes statistically significant, pooled findings for the other interventions should be considered tentative until corroborated by more research. It would appear that one of the barriers to clinicians recommending non-antibiotic alternatives for the treatment of rUTI is the lack of currently available clinical evidence. The campaign for antibiotic stewardship and more prudent prescribing of antibiotic agents can only be strengthened by further work exploring effectiveness of non-antibiotic alternatives. A further conclusion from this meta-analysis was that Large head-to-head trials should be performed to optimally inform clinical decision-making.

    Read Also: How Do I Get Antibiotics Without Insurance

    Recurrent Urinary Tract Infection Treatment

    Recurrent urinary tract infections are UTIs that keep happening despite treatment. With time, some bacteria may stop responding to an antibiotic. This is called resistance, which makes effective UTI treatment more difficult.

    To ensure the best possible treatment for your UTI symptoms, our specialists will inspect your bladder and urethra and possibly your whole urinary tract system to ensure that treatment with antibiotics alone will control the infection. There are times when your physician will work with other specialists if your treatment requires specific antibiotic therapy.

    With recurrent UTIs, it is important to make sure that the antibiotic used has completely cleared the UTI. To check this, a urine culture is repeated. This is called a test of cure because it ensures that the treatment has been effective. A TOC is a urine culture that is performed within 7-14 days after completing the last pill of the treatment antibiotic.

    Some people with recurrent urinary tract infections may need to take a daily antibiotic for 6-9 months to help prevent another infection after completing the treatment course. This is called a suppression or prophylaxis antibiotic. It is usually a low dose of an antibiotic that has minimal long-term side effects.

    Treatments For Recurrent Uti In Elderly Patients

    Urinary Tract Infections

    Is there a role for suppressive antibiotic therapy in geriatric patients with recurrent urinary tract infections ? Is there any scientific evidence in support of cranberry supplements ? ELIZABETH HALL, MSN, APRN, FNP-C, Dayton, Ohio

    Cranberry juice inhibits adherence of uropathogens to uroepithelial cells, thus preventing pathogenic colonization. Clinical research shows that consuming cranberry juice cocktail 300 ml daily or cranberry capsules 400 mg b.i.d. daily for six months significantly reduced UTIs in elderly women compared with placebo . There is no evidence that cranberry juice or tablets are effective for treating an acute infection.

    Suppression antibiotic therapy in the geriatric population is another concern. Prophylaxis has been advocated for women who experience two or more symptomatic UTIs within six months or three or more in 12 months. The choice of antibiotic should be based on susceptibility patterns causing the patients previous UTI.

    Eradication of a previous UTI must be assured by obtaining a negative culture one to two weeks after treatment. Numerous studies have demonstrated that continuous prophylaxis decreases recurrence by up to 95% compared with placebo. However, antibiotic resistance is always a concern, as is the risk of the development of Clostridium difficile diarrhea.

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    Recurrent Uti Treatment Specialists

    Finding the proper specialist to treat your UTIs is an important step, as discussed by UK reality TV star . There are very few practitioners who specialize in the treatment of recurrent urinary tract infections, but we maintain a list by region of those we have come across in our research.

    If you would like more information on specialists in your area, its best to get in touch with us directly. We cant guarantee we can help, but feel free to reach out.

    And please get in touch if you would like to recommend a practitioner who has helped you!

    Below weve highlighted just a few specialists that have spent years gaining insight into recurrent UTI in order to help their patients.

    Pulsing Low Dose Antibiotics

    One of the popular approaches is a combinatory long-term antibiotic suppressive therapy that supposedly attacks bacteria as they emerge. The so-called Dr. Marshall Protocol or is based on administering very low pulsating doses to patients for a prolonged period of time. Marshall, who has a Ph.D. in electrical engineering, invented and tested this protocol to cure himself of a rare disease and then suggested that his protocol could be applied to almost any infectious or inflammatory disease.

    There are some researchers that agree with the general approach: cycling of a variety of antibiotics to attack biofilms and persisting bacteria from all angles. In her article The Riddle of Biofilm Resistance, Dr. Kim Lewis of Tulane University discusses the mechanisms by which pulsed, low-dose antibiotics are able to break up biofilms, while antibiotics administered in a standard manner cannot. However, Lewis herself notes that a concern about patients developing antibiotic resistance given that this protocol would involve short antibiotic cycles and time between cycles free from antibiotics.

    However, as per dr. Marshall, the key to the protocol is a certain medication that supposedly strengthens patients immune defenses leading to complete eradication of the embedded infection.

    My non-medical position on this is similar, I believe the best treatment for a chronic embedded UTI is a systemic holistic approach.

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    What Is The Best Antibiotic For Uti

    We see hundreds of questions in forums, along the lines of, Can I use for a UTI?

    It is important to understand that there is no such thing as the best antibiotic for a UTI.

    There IS such a thing as the best antibiotic for the specific type of bacterium causing YOUR UTI. Antibiotic susceptibility testing can help identify possible treatment options.

    And although some types of bacteria are more common than others when it comes to causing UTIs, its really important you realize, the cause of YOUR UTI is unlikely to be the same as the cause of a random online strangers UTI.

    Just because their UTI treatment was successful, it does not mean the same UTI treatment will work for you.

    More importantly, there is increasing doubt over whether short course antibiotics provide any benefit at all in cases of recurrent UTI caused by a persistent, embedded bladder infection.

    I always took antibiotics as soon as I felt UTI symptoms. It would pretty much clear up by the next day. Then I got a UTI when I didnt have my antibiotics with me. I freaked out, but by the next day it had cleared up anyway. Now I have no idea whether the antibiotics even help.

    Temporary flare ups of UTI symptoms caused by a chronic infection may or may not be relieved faster than when non-antibiotic treatments are used. This means, the antibiotics you rely on for UTI treatment every time you get symptoms may not be making any difference whatsoever.

    Screening Clinical Records And Face To Face

    Recurrent UTI’s After SCI: How I Cured my Chronic Infections and Reduced my Antibiotic use by 95%

    Clinical staff at each site will identify eligible participants through direct contact or by searches of electronic records held in each trust. They will then give or send potentially eligible patients brief study information. Interested potential participants can then agree to be approached by research staff and provided with further study information. Trial invitation information will include brief details of the need and purpose of the study and eligibility criteria. It will emphasise the pragmatic nature of the study and give a realistic indication of the burden to participants. All patients given trial information will be recorded in the screening logs at each site. All subjects who agree to consider participation will be seen by local research staff or the trial coordinator at the respective site to go through the consent and randomisation procedure. A CRF will be initiated and baseline data collected.

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    Alternative Testing Options For Recurrent Uti

    Weve explained why your standard test result may be negative and hopefully you now realise that a negative test result is not the end of the road.

    Remember to trust your body, if you still have symptoms, you likely still have an infection. And if conventional UTI testing methods have failed to provide answers, there are alternative UTI test methods you can try. Here are a few of them:

  • Next generation Sequencing: Used to identify bacteria, fungi and parasites in a urine sample from a large DNA database. Can also provide predictions around antibiotic resistance genes and recommendations for which antibiotics are likely to be most effective.

  • Deep Metagenomic Sequencing: Looks for all known bacteria, fungi, parasites and viruses in one single test, using an expansive DNA database. Can also provide antibiotic recommendations based on resistance genes found.

  • Pooled Antibiotic Susceptibility Testing: Considers the antibiotic sensitivity of the bacterial community as a whole, as well as individual pathogens.

  • Expanded Quantitative Urine Culture : Uses a modified urine culture protocol that builds on the standard concept of urine culture with changes such as larger volumes of urine, and different conditions and times for incubation.

  • Fresh Sample Urine Microscopy Test: Analyzes a urine sample immediately under a microscope to look for things like bacteria, fungi, white and red blood cells, and epithelial cells.

  • Long Term Antibiotics For Uti

    Treatment of biofilms or embedded infection within the bladder may take a longer term approach.

    Weve discussed elsewhere on our site the difficulty of treating an infection encased in a biofilm, or within the bladder wall.

    Bacteria can live for 6 months or more protected within their biofilm or within the bladder wall. The long-term duration of treatment is in part considered necessary because of this lifecycle.

    Periodically, bacteria may escape from a biofilm and either be flushed from the body, or attach to the bladder wall to form new biofilm communities.

    The idea behind a constant regimen of high dose antibiotics over six months or more, is that any bacteria that do escape into the urine will hopefully be eradicated before reattaching to the bladder wall.

    And eventually, the lifecycle of the already embedded bacteria will also have come to an end.

    The best case scenario with long term high dose treatment is that the bacterial community within any biofilm is destroyed.

    The main difference between this type of UTI treatment, and the continuous prophylactic antibiotic treatment mentioned above, is the dosage.

    Prophylactic doses are low, and are intended to prevent acute episodes. Biofilm treatment doses are high, and are intended to eradicate the infection completely over time.

    One protocol for long term antibiotic treatment for chronic UTI has been demonstrated in the UK.

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    Recurrent Uti: What It Is And What To Do About It

    If you get urinary tract infections all the time, or even just a couple of UTIs in fairly quick succession, youre among millions of people around the globe who suffer from recurrent UTIs. For a health issue that is so widespread, there is a surprising lack of information about it.

    In this article well explain what recurrent UTI is and what you can do about it. Before we dive into recurrent UTI, however, lets start at the beginning…

    Bacterial Biofilms Are Undetectable By Regular Tests

    empiric antibiotics for childhood Uti.

    Quite exciting from a scientific point of view, but pretty disturbing if you are trying to fight infection is the ability of the bacteria to enter a latent state during harmful conditions.

    The worst thing is that not only this keeps bacteria alive in a long run, but also makes them undetectable for tests,and without obvious symptoms in a patient. Thats why it is hard to differentiate between a chronic embedded UTI and a recurrent UTI.

    According to new research, members of microbial communities periodically wake upfrom the state of dormancy and send out scouts to test the environment and see if it is the right time for them to start growing again. This ability called quorum sensing.

    Quorum sensing is a form of bacterial cell-to-cell communication whereby bacteria secrete and detect signaling molecules known as autoinducers

    In this scenario, if the scouts sense that the environment is now hospitable, they would signal the remaining cells to wake up and start multiplying, which will result in detectable UTI symptoms.

    However, if the scouts bring back bad news, the colony will lay low until the next opportunity and would be not detectable in dipstick urine analyses.

    Thats why diagnosing bacterial biofilms with standardized tests is next to impossible.

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    Recurrent Urinary Tract Infections In Women: Diagnosis And Management

    CHARLES M. KODNER, MD, University of Louisville School of Medicine, Louisville, Kentucky

    EMILY K. THOMAS GUPTON, DO, MPH, Primary Care Medical Center, Murray, Kentucky

    Am Fam Physician. 2010 Sep 15 82:638-643.

    Recurrent urinary tract infections are common in women and associated with considerable morbidity and health care use. The clinical features, diagnostic testing, and causative organisms are often similar to those of single cases of UTI, although there are additional treatment strategies and prevention measures to consider with recurrent UTIs.


    A urine culture with greater than 102 colony-forming units per mL is considered positive in patients who have symptoms of UTI.

    Clinical recommendation Evidence rating References

    Continuous and postcoital antimicrobial prophylaxis have demonstrated effectiveness in reducing the risk of recurrent UTIs.

    Cranberry products may reduce the incidence of recurrent symptomatic UTIs.

    Use of topical estrogen may reduce the incidence of recurrent UTIs in postmenopausal women.

    Treatment of complicated UTIs should begin with broad-spectrum antibiotic coverage, with adjustment of antimicrobial coverage guided by culture results.

    Prophylactic antimicrobial therapy to prevent recurrent UTIs is not recommended for patients with complicated UTIs.

    UTI = urinary tract infection.


    UTI = urinary tract infection.

    Urinary Tract Infection Symptoms

    Lower UTI symptoms may include the following:

    • Blood in the urine

    • Pain or burning during urination

    • Difficulty urinating

    • Strange sensations or pain in the pelvic region

    • Pain during sex

    Upper UTI symptoms may include the following:

    • Upper back pain

    • Vomiting

    • Fever, chills or the shakes

    *Note: Upper UTI infections shouldnt be ignored, as they can be life-threatening if bacteria pass from an infected kidney into the blood. If you have symptoms of a UTI, dont wait to see if theyll go away on their own, as theres always a chance they wont and could even get much worse. See a doctor.

    Chronic Urinary Tract Infection Symptoms may include the following:

    • Frequent urination

    • Pain or burning during urination

    • Kidney pain

    • Pain in your bladder region

    • Pain radiating to genitals

    • A constant urge to go to the bathroom

    • Premenstrual aggravation of symptoms

    • Urethral pain

    Also Check: Kidney Infection Treatment With Antibiotics

    Removal Of Foreign Bodies

    As discussed earlier, any foreign object becomes a surface where bacteria can build theirhome. Bacteria are able to stick to metals, plastics, and stones even stronger than to your bladder lining cells.

    Any foreign body provides an ideal surface for biofilms to form on. If you have been experiencing chronic UTIs and have a stone, a catheter, or bladder mesh, or an IUD you would want that removed or at least replaced in order to be successful in bacterial biofilm UTI treatment.

    A couple of important points about changing a catheter from

  • Change of the infected catheter is not difficult however, the time to change is important.
  • It is recommended to change the infected UC after 48 h of adequate and sensitive antibiotic treatment to minimize the bacterial concentration in the bladder and urinary tract otherwise, the new UC would be colonized quickly by the bacteria to form a new biofilm.
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