Wednesday, July 24, 2024

Low Dose Antibiotics For Recurrent Uti

What Does Current Guidance Say On This Issue

Recurrent Urinary Tract Infections (UTIs) | What You Need to Know About UTIs | IntroWellness

NICE 2017 guidelines focus on the question of antibiotic prophylaxis for long-term indwelling urinary catheters and in this situation recommend that prophylactic antibiotics should not be routinely given. However, they may be considered for people who have either a history of symptomatic UTIs after catheter change, or who experience trauma during catheter changes.

Current NICE guidelines make no recommendation on the use of antibiotic prophylaxis in intermittent self-catheterisation.

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.

Daily Antibiotics Most Effective In Preventing Recurrent Urinary Tract Infection

Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center
While daily antibiotic use is the most effective method for preventing recurrent urinary tract infections in women, daily cranberry pills, daily estrogen therapy and monthly acupuncture treatments also have benefits that may be preferable for some patients.

While daily antibiotic use is the most effective method for preventing recurrent urinary tract infections in women, daily cranberry pills, daily estrogen therapy and monthly acupuncture treatments also have benefits that may be preferable for some patients, according to a new study by researchers at the Los Angeles Biomedical Research Institute .

The study, published in the Jan. 15 issue of the journal, Clinical Infectious Diseases, said more than half of women suffer from a urinary tract infection at some time in their lives, often requiring antibiotics or other treatments to recover from the infections.

A smaller group of women will have three or more urinary tract infections per year and may require a more pro-active course of treatment to prevent these recurrent infections. The LA BioMed study is the first to use a modeling approach to compare the effectiveness of all of the most commonly used prophylactic measures.

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Uti And Menopause May Be Directly Linked To Lactobacillus In The Vaginal Microbiome

What happens after menopause? Studies have shown that post-menopausal females tend to lose Lactobacillusand their vaginal microbiomes become more diverse2-4.

This change can be influenced by Hormone Replacement Therapy .

Studies have shown that post-menopausal females who have been on HRT for years tend to have more of a Lactobacillus dominant community compared to females of the same age not on HRT.

Assessment Of Study Adherence


Some participants or their clinicians will seek to change their allocated group at some point during trial participation either due to lack of efficacy or adverse effects for either treatment. Trial literature will emphasise the need to adhere to the allocated strategy during the 12-month trial period if possible and will record any deviation. Multiple switching between prophylactic antibiotic agents will be allowed. If participants do stop their allocated treatment within the 12-month treatment period or if they re-commence prophylaxis during the subsequent 6-month observation period this will be recorded and the participant will continue on study unless they withdraw consent.

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What Oral Antibiotics Are Used To Treat An Uncomplicated Uti In Women

The following oral antibiotics are commonly used to treat most uncomplicated UTI infections :

Your doctor will choose your antibiotic based on your history, type of UTI, local resistance patterns, and cost considerations. First-line options are usually selected from nitrofurantoin, fosfomycin and sulfamethoxazole-trimethoprim. Amoxicillin/clavulanate and certain cephalosporins, for example cefpodoxime, cefdinir, or cefaclor may be appropriate options when first-line options cannot be used.

Length of treatment for cystitis can range from a single, one-time dose, to a course of medication over 5 to 7 days. Kidney infections may require injectable treatment, hospitalization, as well as a longer course of antibiotic, depending upon severity of the infection.

Sometimes a UTI can be self-limiting in women, meaning that the body can fight the infection without antibiotics however, most uncomplicated UTI cases can be treated quickly with a short course of oral antibiotics. Never use an antibiotic that has been prescribed for someone else.

In men with symptoms that do not suggest a complicated UTI, treatment can be the same as women. In men with complicated UTIs and/or symptoms of prostatitis are not present, men can be treated for 7 days with a fluoroquinolone . Tailor therapy once urine cultures are available.

Option #: Uti Symptoms Return After Antibiotics

Another story is when your urine test did show a UTI. You then took antibiotics, felt completely fine, but several days later woke up with the same nasty UTI symptoms.

Here two options are possible: we were unable to eliminate the infection completely or it is reinfection, says Dr. Hawes if only 2-3 days elapsed since treatment and symptoms recurred, most likely we were not able to clear the infection. However, if you get an infection 2-3 weeks after your last antibiotic treatment, count it as reinfection.

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Bacterial Interference: Escherichia Coli Strain 83972

The intentional colonization of the bladder with a non-virulent strain, also called bacterial interference, has been studied among patients with neurogenic bladder. E. coli 83972 is a clinical strain, isolated from a woman with chronic urinary colonization and which has naturally lost its capacity to develop Type 1 and Type P fimbriae. This strain has been used for prophylactic purposes to deliberately colonized the bladders with this bacterium to prevent colonization/infection by pathogenic species.

In a mouse model of UTI, E. coli 83972 demonstrated a better fitness than a virulent strain of UPEC. In a poor environment, like the bladder, this difference in fitness is a crucial advantage for the competition between bacteria. The 83972 strain could reduce the impact of UTIs by a monopolization of resources and space .

Seven clinical studies are available: three are RCT, one of which is a crossover designed study and four are prospective cohorts . Sample sizes were small and varied from 12 to 44 patients. Clinical endpoints were the interval before first recurrence or the incidence of UTI during follow up.

Despite this heterogeneity, all studies demonstrated the ability of non-virulent strain to protect patients from UTI. One limit is the difficulty to achieve bladder colonization with the non-virulent strain .

Common Side Effects With Antibiotic Use

D-Mannose & How I Cured My Chronic UTIs Without Antibiotics | D Mannose For UTI Prevention

Each antibiotic is responsible for its own unique list of side effects, and the list is usually extensive. Be sure to discuss your individual antibiotic side effects with your healthcare provider. However, there are side effects that are common to most antibiotics, regardless of class or drug:

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Causes And Symptoms Of A Uti

Many people refer to a UTI as a bladder infection, but you can get an infection anywhere along your urinary tract. That includes your:

  • Bladder the sac that holds your urine.
  • Urethra the tube that carries urine out of your body from your bladder.
  • Ureters 2 tubes that send urine from your kidneys to your bladder.
  • Kidneys the organs that filter your blood and remove wastes that become urine.

Most of the time, a UTI affects your bladder. It happens when bacteria enter your urethra and settle in your bladder. Once bacteria start to grow, they cause symptoms like:

  • Pain or burning when you urinate.
  • Urine thats cloudy, pink from blood, or has an odor.
  • Feeling like you have to urinate frequently, even though your bladder is empty.
  • Pressure or cramping in your lower abdomen.

A kidney infection is a less common UTI, but its more serious. With a kidney infection, your symptoms might include:

  • A fever.

What Is The Evidence For Uncertainty

Despite the existence of several up to date Cochrane meta-analyses on the subject of recurrent UTI prevention, uncertainty remains because of the lack of good quality comparative head to head trials. Consequently, precise quantification of the risks and benefits of prolonged non-antibiotic treatments is yet to be established.â

What are the non-antibiotic treatment options?

Urinary alkalinisation

Urinary alkalisation is the administration of oral medications, such as potassium citrate, to reduce the acidity of urine. By raising the pH of urine, it is postulated that the severity of dysuria experienced by the patient is reduced.


Probiotic organisms are thought to establish a barrier against infectious pathogens ascending the urinary tract and subsequently causing infection. They modulate host defences by reducing pathogen adherence, growth, and colonisation.

Chinese herbal medicine

According to a 2015 Cochrane review, the Chinese herbal medicines most commonly used are Er Xian Tang, Bai Tou Weng Tang, and San Jin Wan.

Methenamine hippurate

Methenamine hippurate11 is hydrolysed to formaldehyde in the presence of acidic urine and exerts a bactericidal effect on E coli.


It is postulated that cranberries prevent bacteria from adhering to the uroepithelial cells.12

Topical oestrogen
Hyaluronic acid

Intravesical hyaluronic acid aims to replenish the surface glycosaminoglycan layer of the urothelium and can prevent bacterial adherence.

Oral immunostimulants

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Complicated Urinary Tract Infections

When there is known or suspected stone disease, pyelonephritis, prostatitis, orchitis or neurogenic bladder, further evaluation is recommended to exclude anatomical abnormalities and urinary obstruction that may need surgery. Infections associated with urinary tract obstruction, such as pyelonephritis due to an obstructing ureteric stone, are a medical emergency. These patients require urgent hospital admission and surgical drainage with placement of a nephrostomy tube or ureteric stenting. It is important that patients with complicated urinary tract infections are prescribed an adequate course of antibiotics usually for at least 1014 days. Therapy should be guided by culture results.

Historical Management Of Utis In Women

Recurrent UTI in females

In the 1800s, management of bladder inflammation included conservative initial treatments whereas more aggressive therapy was reserved for patients who did not improve or deteriorated during initial therapy. Aggressive treatment included mustard- or ammonia-based plasters, oral alkali, bleeding and large doses of acid solutions. In the later 1800s, William Osler described an initial treatment consisting of absolute rest, cold applied to the loins or dry cups to the lumbar region, and amylnitrite and quinine in large doses. If these treatments were ineffective, therapy involved acetates of lead and opium, followed by ergot, gallic and tannic acid, or diluted sulphuric acid. The era of modern evidence-based urology began with the recognition that cystitis was infectious in origin. Beginning in the 1900s, trials with chemotherapeutic agents such as hexamine, phenazopyridine, hexylresorcinol, and Mercurochrome were undertaken, initially with some success and then later with some pessimism. Sulfanilamide, introduced in 1937, ushered in the era of modern antimicrobial therapy for UTIs.

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Recurrent Uti And Menopause May Be Linked By Estrogen Levels

So where does estrogen come in? How are UTI and menopause linked?

It is thought that estrogen increases the stores of glycogen on the surface of the vaginal epithelial cells .

Glycogen acts as a food source for Lactobacilli. The more glycogen that is available, the more the Lactobacilli eat, and the more they multiply. And as mentioned above, abundant Lactobacilli provide a lactic acid rich, protective environment.

When females go through menopause and the levels of estrogen are reduced, this food source also diminishes, and so do the Lactobacilli and accompanying protective acid.

Data Extraction And Quality Assessment

One reviewer extracted study characteristics and outcome data from included trials. We contacted two authors for subgroup data on postmenopausal women. One author replied and provided relevant outcome data. Two reviewers independently assessed the risk of bias of the included studies using the Cochrane Collaborations risk of bias tool. Disagreements were resolved through discussion. We used RevMan V.5.3 to meta-analyse the data and generate forest plots.

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When Urinary Tract Infections Keep Coming Back

Image: Thinkstock

If you are prone to recurrent UTIs, you can head them off before they take hold.

Unless you’re in the fortunate minority of women who have never had a urinary tract infection , you know the symptoms well. You might feel a frequent urgency to urinate yet pass little urine when you go. Your urine might be cloudy, blood-tinged, and strong-smelling. For 25% to 30% of women who’ve had a urinary tract infection, the infection returns within six months.

If you have repeated UTIs, you’ve experienced the toll they take on your life. However, you may take some comfort in knowing that they aren’t likely to be the result of anything you’ve done. “Recurrent UTIs aren’t due to poor hygiene or something else that women have brought on themselves. Some women are just prone to UTIs,” says infectious diseases specialist Dr. Kalpana Gupta, a lecturer in medicine at Harvard Medical School.

Should You Try Uti Home Remedies

Sex, Fertility & Antibiotic Side Effects: Professor Malone-Lee on Chronic UTI, Part 4

The only person that can make this decision is you. And before deciding, you should learn what you can about any UTI remedy youre considering.

An its important to understand this:

The absence of evidence around non-antibiotic UTI treatments does not mean they do not work, but it does mean we dont know if they work.

Just because a number of people agree in a UTI forum that a particular remedy works for them, it does not mean it will work for you, or that it even works at all.

Think about it If you rely on a specific home remedy every time symptoms of a UTI flare up, yet you continue to get UTIs, you can almost guarantee that remedy is not addressing the underlying problem.

Obviously, this does little to curb the enthusiasm for natural UTI remedies online. There is always plenty of discussion on how to treat your next UTI, but very little around resolving the issue so it never happens again.

Its essential to separate the myths from fact there are natural UTI remedies that are looking very promising as future UTI treatment options, but there are other very well publicized natural UTI remedies that have been proven ineffective.

It can be difficult to figure out who to believe. So in our UTI home remedies article weve taken a look at how home remedies stack up, including D-mannose and vitamin C.

Recommended Reading: How To Cure Uti At Home Without Antibiotics

Who Needs Antibiotics For Uti

While the question seems like it answers itself, treatment of UTIs is not always a straightforward affair. There are different bacteria involved, infections are discovered at different points in their pathology, and different people respond to antibiotics differently. So, while anyone suffering from a UTI will probably need to consider antibiotics, which one is the right one will vary from case to case and from person to person.

How the antibiotic is administered will also need to be determined on a case by case basis. As will the duration of treatment. These days, single-dose antibiotic treatment may also be a viable alternative.

What Conditions Are Related To Recurrent Utis

Recurrent UTIs sometimes happen along with other conditions, such as:

  • vesicoureteral reflux , which is found in 30%50% of kids diagnosed with a UTI. In this congenital condition, pee flows backward from the bladder to the ureters. Ureters are thin, tube-like structures that carry pee from the kidney to the bladder. Sometimes the pee backs up to the kidneys. If it’s infected with bacteria, it can lead to pyelonephritis.
  • hydronephrosis, which is an enlargement of one or both kidneys due to backup or blockage of urine flow. It’s usually caused by severe VUR or a blocked ureter. Some kids with hydronephrosis might need to take daily low doses of antibiotics to prevent UTIs until the condition producing hydronephrosis gets better or is fixed through surgery.

But not all cases of recurrent UTIs can be traced back to these body structure-related problems. For example, dysfunctional voiding when a child doesn’t relax the muscles properly while peeing is a common cause of UTIs. Not peeing often enough also can also increase a child’s risk for recurrent infections. Both dysfunctional voiding and infrequent urination can be associated with constipation.

Rarely, unrelated conditions that harm the body’s natural defenses, such as diseases of the immune system, also can lead to recurrent UTIs. Use of a nonsterile urinary catheter can introduce bacteria into the urinary tract and also cause an infection.

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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.

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