Conservative Approach To Prevention
A number of risk factors, other than sexual activity, have been identified in patients with recurrent UTIs. Contraceptive methods employing a diaphragm and/or spermicides and tampon use have been associated with increased risk of UTI., Contraceptive methods should be changed, spermicidal agents should be discontinued, and patients should consider using pads instead of tampons. Drinking cranberry juice or cranberry extract appears to be a safe and possibly effective method of reducing the frequency of recurrent UTIs in some women. Attempting to change the vaginal flora by douching with lactobacilli has been suggested but not proven. It is probable that in the future, some form of immunization program will be the key to prevention of recurrent UTIs. It is probably appropriate to suggest that patients stay hydrated, void regularly, avoid feminine hygiene products such as vaginal douches and scented bubble baths, and practice proper toilet habits , although none of these practices has proven to be effective in reducing the incidence of recurrent UTIs.
Does Taking An Antibiotic After Sex Prevent Utis
According to the American Academy of Family Physicians, having sex three or more times a week increases your risk for recurrent UTIs. Your risk is also increased if you use a diaphragm or spermicide products, regardless of the frequency of sexual activity. If you experience recurrent UTIs, changing your method of contraception should be the first thing you consider.
If you continue to suffer from UTIs and they are getting in the way of living a normal life, taking a preventive antibiotic could be an option. Taking regular antibiotics is not a risk-free treatment though, so have a conversation with your provider about whether this is right for you. Taking an antibiotic before or after sex can prevent recurrent UTIs especially if UTIs repeatedly show up 24 hours after intercourse.
During sex, bacteria can get into the urinary tract and cause infections. Antibiotics work by fighting these bacteria. E. coli is the most common bacteria that causes UTIs. Common antibiotics used to treat UTIs are nitrofurantoin, cephalexin, or trimethoprim/sulfamethoxazole .
A clinical trial showed that only 2 out of 16 women who took TMP/SMX right after sex had recurrent UTIs compared to 9 out of 11 women who had a sugar pill. The results were the same regardless of how often the women had sex.
Utis In The Elderly: Quick Facts
- UTIs are very common and only increase with age: Half of all women will have a UTI in their lifetime.
- UTIs are the most common infection in people over 65, whether they live independently or in nursing homes.
- UTIs cause 5% of all ER visits in the elderly.
- UTIs are more common in elderly women- about 30% of women per year1- at two to three times the rate of men.
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Alternative Therapeutic Options To Antibiotics For The Treatment Of Urinary Tract Infections
- 1VBMI, INSERM U1047, Université de Montpellier, Service des Maladies Infectieuses et Tropicales, CHU Nîmes, Nîmes, France
- 2VBMI, INSERM U1047, Université de Montpellier, Service de Microbiologie et Hygiène Hospitalière, CHU Nîmes, Nîmes, France
- 3Service des Maladies Infectieuses, AP-HP Raymond-Poincaré, Garches, France
- 4PRES Centre Val de Loire, Université François Rabelais de Tours, Tours, France
- 5Service des Maladies Infectieuses, CHU Tours, Tours, France
- 6Service dUrologie, CHU Tours, Tours, France
The Pros And Cons Of Prophylactic Antibiotics For Uti Treatment
|PROS||Studies show, that for the duration of prophylactic antibiotics for UTI treatment, females experience up to a 95% reduction in UTI recurrences. Our interviewees that rely on prophylactic antibiotics find the anxiety related to a potential recurrence is reduced with the knowledge that it is less likely.|
|CONS||Studies show that once prophylactic treatment is ended, females are likely to return to the same rate of UTI recurrence they experienced before they commenced the treatment. Any type of antibiotic use comes with potential side effects, which include destroying good bacteria in the gut and increasing the risk of yeast infection. Research has found that prophylactic antibiotics for UTI treatment promote the development of antibiotic-resistant forms of UTI-causing E.coli .|
This last point is extremely important. Without even knowing it, by taking ineffective antibiotics you could be encouraging a difficult-to-treat embedded infection to form in your urinary tract.
For this reason alone, specialists in the area of chronic urinary tract infections do not recommend the use of low dose antibiotic regimens for UTI treatment.
So while you may find prophylactic antibiotic treatment helpful, there is a good chance your UTIs will return if you cease the treatment, and you may actually be making your condition worse.
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What Issues Are There With Bladder Instillations
- There are no large randomised control studies to demonstrate long term efficacy for the management of chronic urinary tract infections using bladder instillations.
- Studies relating to patients without neurogenic bladder problems or those who have undergone renal surgery focus on the replenishment of the GAG layer in the bladder. The European Urological Association noted:A recent review of 27 clinical studies concluded that large-scale trials are urgently needed to assess the benefit of this type of therapy. Therefore, no general recommendation is possible at this stage. This Cochrane Review published in 2016 confirms these findings.
- There are no standardised treatment regimes instillations in trials have been offered daily for a week, every third day or once a week
- Antibiotics used in instillations are often generic medications thus no pharmaceutical manufacturing company has carried out its own trials on generic antibiotics used in instillations. This means that clinicians often have to develop their own treatment regimes you may come across the words rescue instills which can include not only an antibiotic but also a steroid and gag layer replenishment agent.
- It is invasive which makes it logistically awkward and adds to the treatment expense offered to patients by local clinical commissioning groups and hospitals
- The usage of catheters may introduce further bacteria into an infected bladder
Current Guidelines For Treatment Of Uti In The Elderly
AntibioticsThe tried and true treatment of a UTI is a course of antibiotics. Of course, this should only be given after a confirmed UTI, meaning a urine test showing infection and symptoms compatible with a UTI.
Treatment length depends on the persons baseline health and the severity of the infection. Generally, an antibiotic course ranges from 1-14 days depending on these factors, as well as the antibiotic is chosen.
Repeating the urine test after finishing the course of antibiotics is not needed.
Recurrent bacteria is common and will only change the plan if the person is symptomatic. It is especially concerning if the person receives multiple courses of antibiotics or never seems to be cured from the UTI.
At that point, the health care provider must look for an underlying cause that is not treated by antibiotics, such as kidney stones or interstitial cystitis.
Delayed treatment- a good option
Importantly, up to half of the women are able to get rid of the UTI within a week, without any antibiotics. Research showed that a one or two day course of ibuprofen is an option in healthy patients with a simple UTI.
Its important that there is a doctor follow up, in case the symptoms continue or get worse.While some studies showed this to be a safe plan, a recent study indicated that postponing antibiotics can put some people at a slightly higher risk of kidney infections and increases the duration of symptoms.
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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.
What Is A Urinary Tract Infection
If you have ever experienced the frequent urge to go the bathroom with painful and burning urination, you have probably experienced a urinary tract infection . UTIs are one of the most common types of infections, accounting for over 10 million visits to health care providers each year. Roughly 40% of women experience a UTI at some time, and in women, it is the most common infection. Healthcare costs related to UTIs exceed $1.6 billion per year.
A urinary tract infection can happen anywhere along your urinary tract, which includes the kidneys , the ureters , the bladder , or the urethra . Most UTIs occur in the bladder and urethra. Common symptoms include frequent need to urinate, burning while urinating, and pain in lower abdomen area.
There are different types of UTIs based on where the bacteria goes. A lower urinary tract infection occurs when bacteria gets into the urethra and is deposited up into the bladder — this is called cystitis. Infections that get past the bladder and up into the kidneys are called pyelonephritis.
Urinary tract infection symptoms may include:
- Pain or burning upon urination
- A frequent or urgent need to urinate
- Passing small amounts of urine
- Blood in the urine or or pink-stained urine
- Urines that looks cloudy
- Strong-smelling urine
- Pain, cramping in the pelvis or pubic bone area, especially in women
Upper UTIs which include the kidney may also present with symptoms of fever, chills, back or side pain, and nausea or vomiting.
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Can Vaginal Estrogen Products Prevent Utis
For women near menopause or who have gone through menopause and get 3 or more UTIs per year, vaginal estrogen may be helpful, according to the American Urological Association . Vaginal estrogen comes as a ring , an insert , or a cream . It is both safe and effective for women in this population who are looking to prevent recurrent UTIs.
That said, in a head-to-head trial of vaginal estrogen inserts compared to a daily preventive antibiotic, vaginal estrogen was not as effective as daily antibiotics. More on this below.
Estrogen works by making the vagina more acidic and increasing the number of healthy bacteria in the vagina. This makes it hard for E. coli to live and hide in there, which prevents them from showing up in the urinary tract later.
Some of the more commonly reported side effects of vaginal estrogen include breast tenderness, vaginal bleeding, and vaginal discomfort like itching, burning, and irritation.
If you are being treated for breast cancer or have had breast cancer, vaginal estrogen is considered safe, but you should speak with your oncologist before starting any estrogen-based products.
Prophylactic Antibiotics For Recurrent Uti Treatment
Prophylactic antibiotics for recurrent UTI treatment sounds complicated, but in reality, it just means preventative antibiotic use. That is, you use antibiotics before you feel any UTI symptoms, in the hope of preventing one from happening at all.
We want to state straight up that there is evidence that long-term prophylactic antibiotics for recurrent UTI treatment do not alter the long-term risk of recurrence.
This basically means that patients with recurrent UTIs who take prophylactic antibiotics may experience a decrease in frequency of symptoms during prophylaxis .
But when they stop prophylaxis, their acute episodes return at the same rate as before their UTI treatment started. This was Emmas experience with prophylactic antibiotics.
Ultimately, long-term prophylactic antibiotics do not appear to alter a patients basic susceptibility to infection in most cases.
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Estrogen For Recurrent Uti Treatment
Can estrogen help for recurrent UTI?
Weve covered this in detail in our content on UTI and Menopause, but for a quick overview
Post-menopausal females that experience recurrent UTI may be prescribed hormone replacement therapy . This could be estrogen in a systemic form or topical form .
So why estrogen? And why in the vagina?
Science has shown that the vaginal and urinary microbiomes are interconnected, and it would appear that a healthy vaginal environment with a good amount of lactic acid can provide some protection from UTIs.
To maintain this healthy vaginal environment, its important that Lactobacilli are abundant. These Lactobacilli multiply when the right source of food is readily available. In this case, that source of food is glycogen that is found on the surface of the vaginal epithelial cells .
The more glycogen that is available, the more the Lactobacilli eat, and the more they multiply. It is thought that estrogen increases the stores of glycogen.
When females go through menopause, the levels of estrogen are reduced, resulting in diminished glycogen stores, and therefore the Lactobacillus population is also reduced.
Studies have shown that estrogen therapy may help reverse this process and result in a reduced risk of UTI.
Learn more about estrogen treatment for UTI.
What Happens When A Uti Goes Untreated
Thanks to early diagnosis and proper treatment, the vast majority of lower urinary tract infections result in no complications. However, if left untreated, a UTI can have serious ramifications notes the Mayo Clinic, including:
- Recurrent UTIs
- Premature birth and low birth weight
- Kidney damage, which can occur is an untreated UTI spreads from the bladder to the kidneys.
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Managing Lower Urinary Tract Infection
1.1.1 Be aware that lower urinary tract infection is an infection of the bladder usually caused by bacteria from the gastrointestinal tract entering the urethra and travelling up to the bladder.
1.1.2 Give advice about managing symptoms with self-care to all people with lower UTI.
Treatment for women with lower UTI who are not pregnant
1.1.3 Consider a back-up antibiotic prescription or an immediate antibiotic prescription for women with lower UTI who are not pregnant. Take account of:
the severity of symptoms
the risk of developing complications, which is higher in people with known or suspected structural or functional abnormality of the genitourinary tract or immunosuppression
the evidence for back-up antibiotic prescriptions, which was only in non-pregnant women with lower UTI where immediate antibiotic treatment was not considered necessary
previous urine culture and susceptibility results
previous antibiotic use, which may have led to resistant bacteria
preferences of the woman for antibiotic use.
1.1.4 If a urine sample has been sent for culture and susceptibility testing and an antibiotic prescription has been given:
review the choice of antibiotic when microbiological results are available, and
change the antibiotic according to susceptibility results if bacteria are resistant and symptoms are not already improving, using a narrow-spectrum antibiotic wherever possible.
Treatment for pregnant women and men with lower UTI
1.1.7 For pregnant women with lower UTI:
Use Of Antibiotics To Prevent Recurrent Urinary Tract Infection
When structural problems in the urinary tract have been excluded, antibiotics are the mainstay of treatment of recurrent urinary tract infection .
There are several forms of antibiotic usage that can help reduce the rate of recurrent UTIs in women including:
- Low dose continuous antibiotic prophylaxis
- This involves taking a very small dose of antibiotic continuously over several months.
- The rationale is to eradicate certain bacteria that cause UTI which live on the skin and in the bowel.
- Low dose continuous antibiotics can also help treat reservoirs of bacteria that may hide inside cells in the wall of the bladder.
Dr. Karen McKertich
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Can Uti Treatment Succeed If Biofilms Are Involved
Biofilms that cause chronic urinary tract infections can be difficult to detect and very hard to treat efficiently. Currently, no guidelines exist to help clinicians and microbiologists detect and treat biofilm infections of the urinary bladder.
|Most UTI guidelines are aimed at management of simple uncomplicated UTI. It can be very difficult to successfully manage complex or recurrent UTI in primary care. If symptoms persist, or where there is diagnostic uncertainty GPs will need to make a referral for specialist assessment.”|
Free-floating bacteria behave very differently to bacteria within a biofilm. Bacteria growing as biofilms are also much more difficult to identify in a urine sample.
No three or five day course of antibiotics designed to treat free-floating bacteria is even going to make a dent on your average biofilm.
As much as we do know about biofilms, the mechanisms behind this phenomenon are still poorly understood. To add another layer of doom, biofilms can be formed by one or multiple species, in complex structures.
If the right treatment is found for one of the species in a biofilm, as its prominence decreases, a second species may rise to take its place.
This doesnt necessarily mean treatment is impossible, but it can take a few rounds of different targeted antibiotics to get to the bottom of a multiple-bacteria biofilm. Learn more in our dedicated section on chronic UTI and biofilm.