Urinary tract infection (UTI) – Care at Mayo Clinic

Urinary tract infection care at Mayo Clinic

Your Mayo Clinic care team

Depending on your condition, your team at Mayo Clinic may include specialists in urology, kidney disease, obstetrics and gynecology, and infectious disease who work closely together to diagnose and treat your problem.

Having all this expertise in a single place means that your care is discussed among the team, test results are available quickly, appointments are scheduled in coordination and the most highly specialized experts in the world are all working together for your health.

Pediatric expertise

For children needing testing or treatment, Mayo Clinic provides a friendly, comforting environment. Parents can stay with their children during some diagnostic tests.

Expertise and rankings

Experience

Experienced specialists at Mayo Clinic can determine the cause and recommend an effective treatment in cases of complicated or recurrent urinary tract infections. Mayo Clinic doctors treat more than 15,000 people with UTIs each year.

Leading-edge treatment

Highly skilled Mayo surgeons, including pediatric urologic surgeons, can perform minimally invasive surgery to correct recurrent problems or abnormalities in the urinary system.

Mayo Clinic in Rochester, Minn., is ranked No. 1 for urology in the U.S. News & World Report Best Hospitals rankings. Mayo Clinic in Phoenix/Scottsdale, Ariz., and Mayo Clinic in Jacksonville, Fla., are ranked among the Best Hospitals in the nation for urology by U.S. News & World Report. Mayo Clinic Children’s Center in Rochester is ranked the No. 1 hospital in Minnesota, and the five-state region of Iowa, Minnesota, North Dakota, South Dakota and Wisconsin, according to U.S. News & World Report’s 2021-2022 “Best Children’s Hospitals” rankings.

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Mayo Clinic has major campuses in Phoenix and Scottsdale, Arizona; Jacksonville, Florida; and Rochester, Minnesota. The Mayo Clinic Health System has dozens of locations in several states.

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Costs and insurance

Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people.

In most cases, Mayo Clinic doesn’t require a physician referral. Some insurers require referrals, or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.

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Treating UTIs: Antibotics, Medication, and Home Remedies

Yes. While taking antibiotics is still considered the gold standard of UTI treatments, there are some things you can do at home that help relieve symptoms, as well. These include:

• Drink plenty of water. Consuming at least six to eight 8-ounce glasses of water daily can help flush away UTI-causing bacteria, setting you up for a quicker recovery. Plus, the more you drink, the more you’ll have to urinate.
• Urinate often. Each time you empty your bladder, you’re helping to flush bacteria out of your system.
• Try heat. Applying a heating pad to your pubic area for 15 minutes at a time can help soothe the pressure and pain caused by UTI-related inflammation and irritation.
• Tweak your wardrobe. Wearing loose cotton clothing and underwear can help you recover from a UTI. (22)
• Go fragrance-free. Make sure your personal hygiene products are fragrance-free to sidestep further irritation, notes the National Institute of Diabetes and Digestive and Kidney Diseases. (22)
• Cut out certain irritants. Caffeine, alcohol, spicy food, raw onions, citrus fruits, carbonated drinks, artificial sweeteners, and nicotine can further irritate your bladder, making it more difficult for your body to heal, per the Cleveland Clinic. (23) 

RELATED: 8 Home Remedies for Urinary Tract Infections (UTI) Symptoms

What About Cranberry Juice for UTI?

It’s a long-held belief that consuming cranberry juice may help prevent and treat urinary tract infections. While it’s true that cranberries contain an active ingredient (proanthocyanidins, or PACs) that can prevent adherence of bacteria to the urinary tract, there is still no evidence that cranberry products can treat a UTI.

One of the reasons: Products like cranberry juice or cranberry capsules are not explicitly formulated with the same amount of PACs that have shown potential in lab studies. Moreover, a 2019 report in the Journal of Urology noted that “the availability of such products to the public is a severe limitation to the use of cranberries for [recurrent] UTI prophylaxis outside the research setting. ” (2)

In all, there’s actually very little high-quality research on the topic of prevention. For instance, a 2016 study in The Journal of the American Medical Association, found that among female nursing home residents, daily consumption of cranberry capsules resulted in no significant prevention of UTIs. (24) 

While consuming cranberry juice or supplements is not considered a first-line treatment of urinary tract infections, in most cases, it can’t hurt. After all, drinking plenty of liquids does dilute your urine and help spur more frequent urination, which flushes bacteria from the urinary tract. The exception: Those who are taking blood-thinning medication, such as warfarin, should not consume cranberry juice. And those with diabetes should be mindful of the high-sugar content of fruit juices.

What Over-the-Counter Treatment Options Are Safe To Use?

In addition to antibiotics, your doctor may recommend phenazopyridine (Azo Urinary Pain Relief, Pyridium). This is an over-the-counter (OTC) medication used to numb the lining of the urinary tract to make urination more comfortable while you wait for the antibiotics to work. (Be aware that the medicine will make your urine turn bright orange.) Another popular OTC UTI product is Cystex, a combo of methenamine, sodium salicylate, and benzoic acid, also meant to ease pain.

It’s very important to note that these products are only meant to relieve pain associated with UTIs. They are in no way meant to replace the use of antibiotics. If you read closely on the AZO website, for instance, you’ll find that the company clearly states “the only clinically proven cure for a UTI is a prescription antibiotic.” Plus, taking this phenazopyridine-based UTI meds may actually interfere with your urine test results. (25)

While both products are generally considered safe, if you’re pregnant or breastfeeding with a UTI, consult with your healthcare provider before taking Cystex. And know that these products have not been reviewed by the FDA for efficacy. (26,27)

Can a UTI Go Away On Its Own?

While most patients with a UTI will be prescribed antibiotics, the truth is, uncomplicated urinary tract infections are often self-limiting, meaning they can potentially run their course sans antibiotic treatment, noted a 2018 report in PLoS Medicine. (28) 

In fact, that same report (a randomized, controlled, double-blind study) found that more than one-half of the women studied experienced a UTI resolution without the use antibiotics. (The women took ibuprofen instead.) However, since kidney infections (pyelonephritis) occurred in 7 out of 181 women using ibuprofen, the researchers concluded that, at this time, they cannot recommend ibuprofen alone as initial treatment to women with uncomplicated UTIs.

A better idea, for now: Simply wait until a positive urine culture comes back before treating with antibiotics.

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.
• Sepsis, a potentially life-threatening complication if your UTI moves into your kidneys (29)

7 Best Ways to Prevent Them

A urinary tract infection (UTI) can be painful and frustrating, especially if it keeps coming back. While antibiotics generally clear up a UTI within a few days, there are also some simple measures you can take to help prevent getting one in the first place.

Keep Bacteria Out of Your System

To say goodbye to burning, frequent urination and other unpleasant symptoms, start with these changes today.

Drink plenty of water, and relieve yourself often. The simplest way to prevent a UTI is to flush bacteria out of the bladder and urinary tract before it can settle in. If you’re well-hydrated, it will be tough to go too long without going to the bathroom.

Wipe from front to back. Bacteria tend to hang around the anus. If you wipe from front to back, especially after a bowel movement, they’re less likely to make it to the urethra.

Wash up before sex, and pee afterward. Use soap and water before sex. This keeps bacteria away from the urethra. And peeing afterward carries any bacteria that entered the urinary tract back out.

Steer clear of irritating feminine products. Skip douches, deodorant sprays, scented powders, and other feminine products with fragrances or chemicals.

Rethink your birth control. A diaphragm, spermicide, or spermicide-lubricated condom can make you more likely to get a UTI because they all can contribute to bacterial growth. If you often get UTIs and use one of these birth control methods, switch to a water-based lubricant for vaginal dryness, and consider trying another birth control method to see if it helps.

Some doctors advise women who get a lot of UTIs to wear cotton underwear, take showers instead of baths, and avoid tight clothes that can trap bacteria near the urethra. While these are simple enough to do, none of them are supported by scientific data.

Check With Your Doctor

If you get UTIs often, your doctor may want you to:

• Start antibiotic treatment on your own when you have symptoms
• Take a daily low dose of antibiotics for a while
• Take a single dose of antibiotics after having sex

After menopause, women have less estrogen in their bodies, which can cause vaginal dryness and make the urinary tract more vulnerable to infection. A vaginal cream with estrogen can help balance the area’s pH and allow “good” bacteria to flourish again.

Cranberry Juice and Supplements

There’s probably no harm in trying, but they’re not a proven fix.

Over the years, a lot of studies have focused on a substance found in cranberries that’s thought to prevent bacteria from sticking to the lining of the urinary tract. None of these studies have shown how much of this substance it would take to help prevent UTIs.

Drinking cranberry juice or taking cranberry pills is usually fine, unless you take a blood-thinning medication, a medication that affects your liver, or aspirin.

Probiotics, especially in a vaginal capsule, and D-mannose, a kind of natural sugar you can buy at health food stores, might help prevent unfriendly bacteria from growing in the urinary tract, but both need to be studied more.

You should talk to your doctor before you try cranberries or any supplements to find out the right dose and to make sure they won’t cause other problems.

How to Prevent A Urinary Tract Infection

If you’ve ever had a urinary tract infection, you know how painful and frustrating they can be, especially if they keep coming back. While antibiotics generally clear up a UTI within a few days, there are also some simple measures you can take to help prevent getting one in the first place.

To say goodbye to burning, frequent urination, and other unpleasant symptoms, start with these changes today. The key is to keep bacteria out of your system.

1. Drink plenty of water, and relieve yourself often. The simplest way to prevent a UTI is to flush bacteria out of the bladder and urinary tract before it can set in. If you’re well-hydrated, it will be tough to go too long without urinating.
2. Wipe from front to back. Bacteria tend to hang around the anus. If you wipe from front to back, especially after a bowel movement, they’re less likely to make it to the urethra.
3. Wash up before sex and urinate after it. Use soap and water before sex. This keeps bacteria away from the urethra. And urinating afterward pushes any bacteria that entered the urinary tract back out.
4. Steer clear of irritating feminine products. Skip douches, deodorant sprays, scented powders, and other potentially irritating feminine products.
5. Rethink your birth control. A diaphragm, spermicide, or spermicide-lubricated condom can make you more likely to get a UTI because they all can contribute to bacterial growth. If you often get UTIs and use one of these birth control methods, switch to a water-based lubricant for vaginal dryness, and consider trying another birth control method to see if it helps.

Some doctors also advise women who get a lot of UTIs to wear cotton underwear, take showers instead of baths, and avoid tight clothes that can trap bacteria near the urethra. While these are simple enough to do, none of them are supported by scientific data.

Ideas to Talk to Your Doctor About

If you get a lot of UTIs, your doctor may consider:

• A daily low dose of antibiotics, taken for 6 months or longer
• Having you test yourself for a UTI at home when you have symptoms
• Taking a single dose of antibiotics after having sex

If you’ve gone through menopause, you could ask about estrogen vaginal cream. After menopause, women have less estrogen in their bodies, which can cause vaginal dryness and make the urinary tract more vulnerable to infection. The treatment can help balance the area’s pH factor and allow “good” bacteria to flourish again.

What About Cranberry Juice?

There’s no harm in trying it. But it’s not a proven fix.

Over the years, a lot of studies have focused on a substance found in cranberries that’s thought to prevent bacteria from sticking to the lining of the urinary tract. But none of these studies have shown how much of this substance it would take to help prevent UTIs.

If you still want to give it a try, drinking cranberry juice or taking cranberry pills is probably fine to do. But there are some exceptions, like if you take a blood-thinning medication, a medication that affects the liver, or aspirin. It’s always wise to talk to your doctor first, before you try any supplements.

Urinary Tract Infections and Self-Care Options

US Pharm. 2017;9(42):4-7.

Urinary tract infections (UTIs) are the most commonly occurring infections, affecting approximately 150 million people worldwide each year.¹ In the United States alone, the societal costs of UTIs are estimated to be $3.5 billion annually.¹ UTIs can affect both men and women, but they are especially common in women of childbearing age.² Most women will experience at least one episode during their lifetime; by 32 years of age, more than half of all women will have reported having at least one urinary tract infection.^2,3 Almost 25% of women will have a recurrent infection within a year.²

A UTI is an infection of the urinary system. UTIs are classified as uncomplicated and complicated.⁴Uncomplicated UTIs are those occurring in healthy, premenopausal women with no urinary tract abnormalities.³Complicated UTIs are caused by abnormalities that compromise the urinary tract, such as urinary obstruction, urinary retention, immunosuppression, renal failure, renal transplantation, and presence of foreign objects; pregnancy is another cause. ¹ Indwelling catheters account for one million cases, or 70% to 80%, of complicated UTIs in the U.S. per year.¹ Complicated UTIs occur in both sexes and often affect the upper and lower urinary tracts. UTIs are further categorized based on location: lower UTIs (cystitis) and upper UTIs (pyelonephritis). Pharmacists will frequently encounter patients inquiring about relief from UTI-related symptoms, so it is important that they understand the various OTC products marketed for the management of UTIs.

Etiology and Risk Factors

Urine is generally sterile, and the causative agents for most UTIs originate in bowel flora that enter the periurethral area. Most UTIs are caused by one organism; UTIs caused by multiple organisms may indicate contamination. The causative agents are gram-positive and gram-negative organisms, as well as some fungi.¹ The gram-negative bacterium Escherichia coli accounts for almost 90% of all episodes.^3,5 Other common causative agents include Staphylococcus saprophyticus, Klebsiella pneumoniae, Enterococcus faecalis, group B streptococcus, Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus aureus, and Candida species.

Women are more likely to develop a UTI because their urethras are shorter than men’s.⁵ Other risk factors include previous episodes of UTI, sexual intercourse, spermicide use, new sexual partner, reduced mobility, changes in vaginal flora, pregnancy, menopause, diabetes, urinary incontinence, kidney stones, prostate enlargement, and history of UTI in a first-degree relative.^2,4,5 In the elderly population, other risk factors to consider are age-related changes in immune function, increased exposure to nosocomial pathogens, and an increased number of comorbidities.⁶ Certain behaviors are thought to contribute to the development of UTIs, such as frequency of urination and delayed voiding, not voiding pre- and postcoitally, consumption of certain beverages, hot tub usage, douching, wiping patterns, and choice of clothing; BMI may also be a factor. A case-control study found no increased risk of UTI development with these practices.⁷

Clinical Presentation and Diagnosis

Patients with cystitis often present with a frequent, persistent urge to urinate despite passing a small amount, dysuria or a burning sensation during urination, or suprapubic heaviness. ⁷ Patients with pyelonephritis often experience flank pain or tenderness, a low fever (<101 F), chills, nausea, vomiting, and malaise with or without symptoms of cystitis.² Patients with a lower or upper UTI may experience hematuria or notice that their urine is cloudy or has a strong odor. Elderly patients tend to present with nonspecific symptoms including altered mental status, change in eating habits, lower abdominal pain, and gastrointestinal symptoms such as constipation.⁶

In most patients who present with signs and symptoms of UTIs, a history of illness is the most important diagnostic tool, especially when symptom onset is sudden or severe and when vaginal discharge and irritation are not present.^2,3 Sometimes, however, UTI diagnosis cannot rely solely on patient symptoms because some patients are asymptomatic; this is more common in older adults than in younger adults.⁶ Laboratory tests, urine-sample tests, and pelvic examinations should be performed in patients with urinary tract symptoms to properly diagnose UTIs. ^2,3 Laboratory tests for UTIs include assessments for the presence of bacteriuria and pyuria, nitrite, leukocyte esterase, and antibody-coated bacteria.²

Commercially available dipsticks may be used to detect the presence of a UTI. The pharmacist can recommend an OTC UTI home test kit to determine whether causative agents of UTI are present. After use, the patient should call the physician with the results for evaluation and treatment. The available test kits detect leukocyte esterase and nitrite. Testing for these substances increases overall sensitivity and specificity and reduces the risk of false-negative results.⁸ Self-testing for UTIs has been proven accurate with proper use, but to avoid inaccurate or false results, patients should be advised to obtain a clean-catch urine specimen and to avoid consuming more than 250 mg of vitamin C within 24 hours of testing; women should not test during their menses.^8,9 A strict vegetarian diet, tetracycline, and phenazopyridine may cause inaccurate results. ⁹

Preventive Measures

Almost 25% of women experience recurrent episodes of UTI.¹⁰ This is defined as either two uncomplicated UTIs in 6 months or three or more positive cultures within the preceding 12 months.¹⁰ UTIs can occur even when precautions are taken, but pharmacists can recommend preventive measures to reduce a patient’s risk for recurrent infections. If a woman is using spermicide-containing contraceptives, she should be counseled about the possible connection between her contraceptive method and recurrent infections, and an alternative form of contraception should be considered. Although studies have not indicated a correlation, behavioral modifications such as staying hydrated, urinating before and after sexual activity, urinating regularly, using tampons instead of sanitary pads and changing them every 3 hours, wiping from front to back, wearing clean cotton underwear and loose-fitting, breathable clothing, and taking showers instead of baths may be helpful. Topical estrogen therapy in postmenopausal women may help prevent UTI recurrences by altering the vaginal flora.^6,11 Evidence for use of acupuncture and immunoprophylactic regimens is limited.¹²

There is little evidence of the efficacy of natural supplements in the prevention of UTIs. Research suggests that the antioxidant proanthocyanidin and the fructose in cranberries can help prevent bacteria, particularly E coli, from clinging to the walls of the urinary tract.¹³ Cranberry products are available in an array of dosage forms: juice, syrup, capsules, and tablets. Data on the efficacy of cranberry juice in preventing recurrent UTIs are conflicting. A recent Cochrane review determined that cranberry products do not significantly reduce the risk of recurrences compared with placebo.¹³ Similarly, the use of probiotics has also been considered for the prevention of UTIs. Probiotics support the body’s normal flora, and it is theorized that probiotics form a barrier against pathogens ascending the urinary tract, preventing the adherence, growth, and colonization of the urogenital epithelium by uropathogenic bacteria.^14,15 To date, data regarding a protective effect of probiotics against future UTIs have been inconsistent, and additional large, well-designed studies are needed to determine the effectiveness of probiotics.¹⁴

Management: Nonprescription Products

Active ingredients found in OTC urinary tract analgesics include phenazopyridine hydrochloride, methenamine, and sodium salicylate (TABLE 1). Phenazopyridine, which provides relief from the pain, burning, itching, and urgency of UTIs, is available in both prescription (100-mg and 200-mg tablets) and OTC form (95-mg and 97.5-mg tablets). The recommended OTC dosage is two tablets three times daily during or after meals with a full glass of water for up to 2 days. Patients with kidney disease or an allergy to dyes should not take this medication. Patients should be advised that their urine may become reddish-orange in color, which is not harmful but can stain clothing. Common adverse effects (AEs) include headache, dizziness, and upset stomach.

Methenamine (an antibacterial) and sodium salicylate (a nonsteroidal inflammatory drug [NSAID]) work in conjunction with one another; sodium salicylate stabilizes the urine pH, allowing methenamine to slow the growth of bacteria along the urinary tract and control the UTI. The recommended dosage is two tablets three times daily. Patients should be advised not to take this product if they are allergic to salicylates, are on a low-sodium diet or anticoagulant therapy, or have stomach problems.

Patients may also take pain relievers, such as NSAIDs or acetaminophen, for general relief of UTI-associated pain.

Role of the Pharmacist

It is imperative that pharmacists urge patients who present with UTI symptoms to consult with their healthcare provider as soon as possible to receive appropriate care. Pharmacists should counsel patients on nonpharmacologic treatments and present the option of nonprescription products and UTI home test kits. Patients who decide to use UTI home test kits should be advised on how to avoid inaccurate results and to discuss their results with their healthcare provider. Patients who decide to use OTC urinary tract analgesics should be counseled on the recommended maximum dosage and duration and on common AEs. It is imperative to remind patients that these products are intended only to provide relief of pain and other related symptoms until the healthcare provider is seen. These products do not eradicate bacteria or replace the use of antibiotic treatment, and they should not be used as monotherapy.

What Causes UTIs?

The bacterium that causes most UTIs is Escherichia coli. UTIs can affect both men and women, but they are more common in women. Although UTIs can affect anyone, some factors that can increase your chance of contracting a UTI include sexual intercourse, menopause, spermicides, pregnancy, older age, obesity, genetics, and antibiotic use.

How Can I Tell if I Have a UTI?

Not all UTIs have obvious symptoms, but signs and symptoms of a possible UTI include the need to urinate often, pain and burning sensations during urination, low fever, nausea, vomiting, feeling ill, and back or abdominal pain. You may also notice that your urine is bloody, cloudy, or odorous.

See your doctor immediately if you think you have a UTI, or ask your pharmacist about purchasing a UTI test kit. If you decide to use the take-home UTI test strips, follow the instructions carefully and be sure to discuss your test results with your doctor.

What Can I Take to Relieve Pain?

Phenazopyridine hydrochloride may relieve your pain, burning, itching, and urgency to urinate within 20 minutes. Avoid taking it if you have kidney disease or are allergic to dyes. Do not worry if your urine turns reddish-orange when you take this medication. This common effect is not harmful, but it can stain clothing.

Methenamine (an antibacterial agent) and sodium salicylate (a nonsteroidal inflammatory drug [NSAID]) work together to slow bacterial growth along the urinary tract and to control the UTI. Do not take this medication if you are allergic to aspirin,  are on a low-sodium diet or anticoagulant therapy, or have stomach problems.

You can also take other pain relievers, such as NSAIDs (aspirin, ibuprofen, naproxen, celecoxib) or acetaminophen (Tylenol).

What Natural Supplements Can I Take to Prevent Another UTI?

There is little evidence that natural supplements can prevent UTIs, but you can try cranberry supplements or probiotics. Cranberries contain antioxidants that may help prevent bacteria in the urinary tract from sticking to the walls of the urinary tract. Drinking 10 to 30 oz of cranberry juice per day may be beneficial. Probiotics may help prevent UTIs by supporting the body’s natural microorganisms in the flora.

What Steps Can I Take to Prevent Another UTI?

Drink lots of water, urinate before and after sexual activity, change tampons regularly, wipe from front to back, wear cotton underwear and loose-fitting clothing, and take showers instead of baths.

Remember, if you have questions, Consult Your Pharmacist.

REFERENCES

1. Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015;13:269-284.
2. Hooton TM. Clinical practice. Uncomplicated urinary tract infection. N Engl J Med. 2012;366:1028-1037.
3. Colgan R, Williams M. Diagnosis and treatment of acute uncomplicated cystitis. Am Fam Physician. 2011;84:771-776.
4. Mody L, Juthani-Mehta M. JAMA patient page. Urinary tract infections in older women. JAMA. 2014;311:874.
5. Minardi D, d’Anzeo G, Cantoro D, et al. Urinary tract infections in women: etiology and treatment options. Int J Gen Med. 2011;4:333-343.
6. Rowe TA, Juthani-Mehta M. Urinary tract infection in older adults. Aging Health. 2013;9:10.2217/ahe.13.38.
7. Scholes D, Hooton TM, Roberts PL, et al. Risk factors for recurrent urinary tract infection in young women. J Infect Dis. 2000;182:1177-1182.
8. Scolaro KL, Lloyd KB, Helms KL. Devices for home evaluation of women’s health concerns. Am J Health-Syst Pharm AJHP Off J Am Soc Health-Syst Pharm. 2008;65:299-314.
9. Azo Test Strips. FAQs. www.azoproducts.com/products/azo-test-strips. 2017. Accessed August 9, 2017.
10. Epp A, Larochelle A, Lovatsis D, et al. Recurrent urinary tract infection. J Obstet Gynaecol Can. 2010;32:1082-1101.
11. Beerepoot MA, Geerlings SE, van Haarst EP, et al. Nonantibiotic prophylaxis for recurrent urinary tract infections: a systematic review and meta-analysis of randomized controlled trials. J Urol. 2013;190:1981-1989.
12. Arnold JJ, Hehn LE, Klein DA. Common questions about recurrent urinary tract infections in women. Am Fam Physician. 2016;93:560-569.
13. Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2012;(10):CD001321.
14. Schwenger EM, Tejani AM, Loewen PS. Probiotics for preventing urinary tract infections in adults and children. Cochrane Database Syst Rev. 2015;(12):CD008772.
15. Falagas ME, Betsi GI, Tokas T, Athanasiou S. Probiotics for prevention of recurrent urinary tract infections in women: a review of the evidence from microbiological and clinical studies. Drugs. 2006;66:1253-1261.

To comment on this article, contact [email protected].

Urinary Tract Infection | Antibiotic Use

baby icon Talk to a healthcare professional right away if your child is younger than 3 months old and has a fever of 100.4 °F (38 °C) or higher.

When to Seek Medical Care

Talk to your healthcare professional if you have symptoms of a UTI or for any symptom that is severe or concerning.

Taking antibiotics, prescribed by a healthcare professional, at home can treat most UTIs. However, some cases may require treatment in a hospital.

Treatment

Your healthcare professional will determine if you have a UTI by:

• Asking about symptoms
• Doing a physical exam
• Ordering urine tests, if needed

Bacteria cause UTIs and antibiotics treat them. However, any time you take antibiotics, they can cause side effects. Side effects can include rash, dizziness, nausea, diarrhea, and yeast infections. More serious side effects can include antibiotic-resistant infections or C. diff infection, which causes diarrhea that can lead to severe colon damage and death. Call your healthcare professional if you develop any side effects while taking your antibiotic.

Sometimes other illnesses, such as sexually transmitted diseases, have symptoms similar to UTIs. Your healthcare professional can determine if a UTI or different illness is causing your symptoms and determine the best treatment.

How to Feel Better

If your healthcare professional prescribes you antibiotics:

• Take antibiotics exactly as your healthcare professional tells you.
• Do not share your antibiotics with others.
• Do not save antibiotics for later. Talk to your healthcare professional about safely discarding leftover antibiotics.

Drink plenty of water or other fluids. Your healthcare professional might also recommend medicine to help lessen the pain or discomfort. Talk with your healthcare professional if you have any questions about your antibiotics.

Prevention

You can help prevent UTIs by doing the following:

• Urinate after sexual activity.
• Stay well hydrated.
• Take showers instead of baths.
• Minimize douching, sprays, or powders in the genital area.
• Teach girls when potty training to wipe front to back.

Urinary Tract Infection (UTI) – Managing Side Effects

Your urinary tract is the system in your body responsible for filtering wastes in
your blood, and excreting wastes out of the body. Your urinary tract consists of
your kidneys, ureters and bladder. Once the kidneys and their nephrons filter excess
wastes that have circulated through your body, they are then able to turn the excess
waste products into urine. The urine flows out of your urethra, and out of your
body.

If you have a urinary tract infection, bladder infection or infection of any part
of your urinary system, your symptoms can lead to serious complications if left
untreated. Bladder infections in normal individuals, who are not undergoing chemotherapy,
can be present for a long period of time. Eventually, in many healthy individuals,
your body’s immune system may take care of a urinary tract infection. However, if
you are undergoing chemotherapy, or are elderly, you may be more susceptible to
the urinary tract infection spreading throughout the urinary tract to the kidneys
(pyelonephritis) or into the bloodstream (urosepsis). What may begin as a mild signs
of a urinary tract infection could escalate to an infection which is much more serious.

Preventing UTIs & Bladder Infections:

Your body has many defense mechanisms in place to prevent urinary tract infections
and bladder infections. These include:

• The design of the urinary system. Your ureters and the drainage system is
  designed for urine to flow out of the body.
• Your urinary system is a sterile environment. This means that there are no bacteria
  normally present. This is a defense mechanism to maintain a “clean” environment.
  Anti-bacterial substances in the lining of the bladder prevent infections.
• Many bacterium are washed out of the body with normal urination
• Your immune system functions to rid the body of bacteria, by killing them
• In men – the prostate gland secretes infection- fighting materials
• In women – the acid level in the vagina of fertile women, is very acidic. Bacteria
  do not like acidic environment. This helps to kill bacteria.
• Most urinary tract infections do not lead to permanent kidney problems, as long
  as they are treated with antibiotics.

Causes of Urinary Tract Infections:

You may develop a urinary tract infection as a result of:

• Certain diseases or conditions – such as differences in your changes in the anatomy
  of your urinary tract. You may have born with these differences, or developed
  later on in your life secondary to surgery or trauma (injury)
• If you have a lowered immune system due to chemotherapy or Acquired Immunodeficiency
  syndrome (AIDS)
• You are more at susceptible to the symptoms of urinary tract infections if you have
  diabetes or are sexually active.
• Women who are pregnant are at a higher risk of urinary infections
• Infections – abnormal bacteria or certain types of fungus (such as yeast) may have
  entered your urinary tract, and caused an infection. This may happen due to the
  way you cleanse yourself following a bowel movement. For women especially, if you
  wipe from the back of your rectal area, to the front of your body, you may contaminate
  your urinary tract, causing an infection.
• Men with an inflammation of their prostate (prostatitis) may develop urinary infections.
• Poor hygiene – people who do not cleanse themselves regularly may be more at risk
  for developing urinary tract infections.

Others at risk for urinary tract infections include:

• Women, and those who are elderly are more at risk for infections, due to their anatomy.
• People who catheterize themselves to urinate (by placing a tube in their bladder)
  are also at risk for infections.
• Your doctor or healthcare provider may need to check your urine for bacteria with
  a sterile urine sample. This is often done to diagnose your condition, and
  sometimes after you have been treated with antibiotic therapy.

Urinary Tract Infection Symptoms:

• You may be experiencing an urgency to go to the bathroom or urinate more frequently.
• You may have pain, or experience a burning sensation, when you urinate. This could
  be due to an inflammation of your urethra (called urethritis)
• You may not be urinating very often. Your urine may be dark or red blood-tinged.
• Your urine may look cloudy, or have blood in it.
• Your urine may have a strong smell or odor.
• You could have pain in your back, pelvis or abdominal area.
• You may have fever or chills, if you have an infection
• You may be overly tired, or very weak (fatigued), if there is an infection present.
• With severe infections, you could experience nausea or vomiting.

Things You Can Do About Urinary Tract Infections:

Prevention Of Urinary Tract Infections:

• Wipe from the front of your body, to the back after a bowel movement. Cleanse with
  soap and water, if possible.
• Wear white cotton underwear. Shower regularly, and keep good hygiene.
• Do not wear tight fitting pants or pantyhose, if possible.
• If you catheterize yourself, make sure to use a good technique. Cleanse the catheter
  well with soap and water after each use. If you are at risk for symptoms of kidney
  problems such as infection due to a lowered immune system, using a sterile
  catheter each time may help decrease your risk of infection.
• Take showers instead of bathing in the bathtub.
• Avoid creams, lotions, feminine sprays or oils near your genital area.
• Empty your bladder often. Do not wait to go to the bathroom if you feel the urge.

Fluids:

• Keep yourself well hydrated when signs of kidney problems are present. Drink two
  to three quarts of fluid every 24 hours, unless you are instructed otherwise.
• Cranberry and blueberry juices have been proven to decrease the incidence of urinary
  tract infections. Chemicals in the cranberries and blue berries may prevent certain
  bacteria from multiplying in your urinary tract.
  Other:
• There is no special diet that you should eat to help prevent urinary tract infections.
  In general, increase the amount of fresh fruits, vegetables and fiber in your diet.
  Avoid excess fats, sugars and red meat.
• Remind your doctor or healthcare provider if you have a history of diabetes, liver,
  heart or prior kidney disease.
• If you are ordered an antibiotic, or another medication to treat this disorder:
• Follow all of your healthcare provider’s instructions. Take all of your medications
  as directed
• Do not stop taking your medication unless your healthcare provider tells you to.
• Take the medication exactly as directed.
• Do not share your pills with anyone.
• Antacids, such as Mylanta^®, Pepcid^®, Nexium^® and others, may
  change the way many medications are absorbed. If you have any questions specific
  to medications that may have been ordered for you, ask your healthcare provider.
• If you miss a dose of your medication, discuss with your healthcare provider what
  you should do.
• If you experience symptoms or side effects, especially if severe, be sure to discuss
  them with your health care team. They can prescribe medications and/or offer
  other suggestions that are effective in managing such problems.
• Keep all your appointments for your treatments.

Drugs That May Be Prescribed by Your Doctor:

Depending on your urinary tract infection symptoms and your overall health status,
your doctor may recommend that certain drugs be used to treat your urinary tract
infection. In addition to maintaining good hydration status (by drinking lots of
fluids), some of the common urinary tract infection treatment drugs may include:

Antibiotics – If your doctor or healthcare provider suspects
that you have a urinary tract infection, he or she may order antibiotics. You will
likely receive your antibiotics in a pill form, if you have a simple infection,
or intravenous (IV) if you have a more serious blood infection. Antibiotics such
as Bactrim^® and Cipro^®,
are commonly used because of their ability to get rid of certain bacteria that are
common to urinary tract infections. If you are prescribed antibiotics, take
the full prescription. Do not stop taking pills once you feel better.

Antispasmodic Agents – If you
are experiencing spasms (or contractions) in your bladder, your healthcare provider
may temporarily prescribe an antispasmodic agent. Your healthcare provider will
determine if this is right for you based on your symptoms of kidney problems.

Phenazopyridine – This medication may be given, in a pill
form, to treat symptoms of pain and discomfort that are associated with a urinary
tract infection. Do not take this medication for more than 2 days, and discontinue
it when your symptoms improve after treatment. Your urine will turn orange while
you are taking this medication, and this may cause your clothing to become stained.
If you notice any kidney problems symptoms of shortness of breath, or confusion,
contact your physician or healthcare provider immediately.

Tylenol^® – Tylenol alone
may provide relief from fever, due to a bladder infection. It is important not to
exceed the recommended daily dose of Tylenol, as it may cause liver damage. Acetaminophen
(Tylenol) up to 4000 mg per day (two extra-strength tablets every 6 hours) may help.

Non-Steroidal Anti-inflammatory (NSAID) Drugs -
NSAID drugs such as ibuprofen and naproxen should be avoided if you have kidney disorders,
because it may cause potential damage to your kidneys.

• Discuss these and all over-the-counter medications with your healthcare provider
  before you take them.
• Your healthcare provider will discuss with you which treatments are helpful to you.
• Do not stop any medications abruptly, without first discussing them with your healthcare
  provider.

When to Contact Your Doctor or Health Care Provider:

• Fever of 100.5° F (38° C), and/or chills (possible signs of infection if you are
  receiving chemotherapy).
• If you begin urinating less frequently, or if your urine is dark, cloudy, or painful.
• Urinary symptoms such as: frequency, urgency, burning, pain on urination, blood
  in the urine.
• Any new rashes on your skin, itchy skin
• Changes in your mental state, including confusion
• If your urinary tract infection symptoms worsen or do not improve in 3 days of therapy

Read More About:
Kidney Problems
| Nephrotoxicity | Azotemia | Proteinuria | Urinary Tract Infection (UTI)

Note: We strongly encourage you to talk with your health care professional
about your specific medical condition and treatments. The information contained
in this website about symptoms of kidney problems and other medical conditions is
meant to be helpful and educational, but is not a substitute for medical advice.

Monural powder for solution sachet 3 g 1 pc

Specifications

Instructions for use

Active ingredients

Form of issue

Powder

Roster

1 package contains: fosfomycin trometamol 5.631 g, incl. fosfomycin 3 g Excipients: tangerine flavor, orange flavor, saccharin, sucrose.

Pharmacological effect

A broad-spectrum antibiotic, a derivative of phosphonic acid, has a bactericidal effect, the mechanism of which is associated with the suppression of the first stage of the synthesis of the bacterial cell wall. It is a structural analogue of phosphoenol pyruvate, enters into a competitive interaction with the enzyme N-acetyl-glucosamino-3-o-enolpyruvyl transferase.As a result, a specific, selective and irreversible inhibition of this enzyme occurs, which ensures the absence of cross-resistance with other classes of antibiotics and the possibility of synergy with other antibiotics (synergism with amoxicillin, cephalexin, pipemidic acid is noted in vitro). It is active in vitro against most gram-positive microorganisms: Enterococcus spp., Enterococcus faecalis, Staphylococcus aureus, Staphylococcus saprophyticus, Staphylococcus spp.; gram-negative microorganisms: Esherichia coli, Citrobacter spp., Enterobacter spp., Klebsiella spp., Klebsiella pneumoniae, Morganella morganii, Proteus mirabilis, Pseudomonas spp., Serratia spp. In vitro, fosfomycin reduces the adhesion of a number of bacteria to the epithelium of the urinary tract.

Pharmacokinetics

Absorption: After oral administration, it is rapidly absorbed from the gastrointestinal tract. Bioavailability with a single oral dose of 3 g is 34-65%.Cmax is reached after 2-2.5 hours and is 22-32 μg / ml. Distribution and metabolism: Fosfomycin trometamol does not bind to plasma proteins, in the body it dissociates into fosfomycin and trometamol (does not possess antibacterial properties) and is no longer metabolized, mainly accumulates in the urine. When taken in a single dose of 3 g in urine, a high concentration is achieved (from 1053 to 4415 mg / l), 99% bactericidal for most common causative agents of urinary tract infections. BMD (128 mg / L) is maintained in urine for 24-48 hours (which assumes a single-dose course of treatment).Excretion: T1 / 2 from plasma – 4 hours. Excreted unchanged by the kidneys (up to 95%) with the creation of high concentrations in the urine; about 5% – with bile. Pharmacokinetics in special clinical cases In patients with a moderate decrease in renal function (CC> 80 ml / min), including its physiological decrease in the elderly, T1 / 2 of fosfomycin is slightly lengthened, but the concentration in urine remains at a therapeutic level.

Readings

Acute bacterial cystitis.Acute attacks of recurrent bacterial cystitis. Bacterial nonspecific urethritis. Asymptomatic massive bacteriuria in pregnant women. Postoperative urinary tract infections. Prevention of urinary tract infection during surgery and transurethral diagnostic studies.

Contraindications

Hypersensitivity to fosfomycin or other components of the drug. Severe renal impairment (CC <10 ml / min).Children under 5 years of age Sugar / isomaltase deficiency, fructose intolerance, glucose-galactose malabsorption.

Precautions

When prescribing the drug to patients with renal insufficiency, the dose should be reduced and the interval between doses should be increased.

Application during pregnancy and lactation

The use of the drug during pregnancy and lactation is possible only if the intended benefit of therapy for the mother outweighs the potential risk of teratogenic effects.

Method of administration and dosage

For adults, the drug is prescribed 3 g 1 time / day. The course of treatment is 1 day. If necessary (in case of severe or recurrent infections, elderly people), it is possible to take the drug again at a dose of 3 g after 24 hours. 3 g 24 hours after the first dose.When prescribing the drug to patients with renal insufficiency, the dose should be reduced and the interval between doses should be increased. Before taking the granules, dissolve in 1/3 cup of water. The drug is taken 1 time / day on an empty stomach 2 hours before or after meals (preferably before bedtime), after emptying the bladder.

Side effects

From the side of the digestive system, nausea, heartburn, diarrhea, other skin rashes, allergic reactions.

Overdose

The risk of overdose is minimal. Treatment: forced diuresis.

Interaction with other drugs

With simultaneous use with metoclopramide, it is possible to reduce the concentration of fosfomycin in serum and urine (this combination is not recommended).

Special instructions

When prescribing Monural to patients with diabetes mellitus, it should be borne in mind that 1 packet containing 2 g of fosfomycin contains 2.1 g of sucrose, and in 1 package containing 3 g of fosfomycin – 2. 213 g of sucrose.

Prescription

Yes

90,000 Antimicrobials for the prevention of urinary tract infections in adults undergoing cystoscopy

Review Question

We reviewed the evidence for the benefits and harms of using antibiotics for cystoscopy (examination of the interior of the bladder) to prevent urinary tract infections (UTIs).

Relevance

Cystoscopy can cause urinary tract infections (UTIs). This intervention can cause unpleasant symptoms, such as a burning sensation when urinating from an infection confined to the bladder, or fever and chills from a more serious infection entering the bloodstream, or a combination of burning while urinating, fever, and chills. Antibiotics can prevent infection and reduce these symptoms, but they can also cause unwanted effects.It is unclear if people should take antibiotics before this procedure.

Research characteristics

We found 22 studies with 7711 participants. These studies were published from 1971 to 2017. In these studies, participants had an equal chance of receiving an antibiotic or placebo / no treatment. The evidence is current to 4 February 2019.

Main results

Antibiotics given before cystoscopy to prevent UTIs may have little or no effect on the risk of a more serious infection spreading into the bloodstream.

They may reduce the risk of infection when both types of infections (serious infections with infiltration into the bloodstream and infections limited to the bladder) are considered together.

None of the participants included in the trial experienced serious adverse effects. Thus, we concluded that antibiotics used to prevent UTIs may not cause serious adverse effects, but we are very uncertain about this conclusion.

Antibiotics may also have little or no effect on minor adverse effects.They may also have little or no effect on infections limited only to the bladder, but we are very uncertain about this conclusion. Participants who received antibiotics were more likely to have bacteria that were more resistant to antibiotics, but we are very uncertain about this conclusion.

Quality of evidence

We rated the quality of the evidence as low or very low, which means that our confidence in the results was limited or very limited.The true effect of antibiotics on the prevention of cystoscopy-associated UTIs may differ significantly from what was found in this review.

Fitolysin – instructions for use

Pharmacotherapeutic group

Herbal diuretic

Indications for use

Infectious and inflammatory diseases of the urinary tract, nephrourolithiasis (as part of complex therapy).

Contraindications

Hypersensitivity to the components of the drug, renal failure, heart failure, glomerulonephritis, phosphate urolithiasis, age up to 18 years.

Use of the drug during pregnancy and lactation

Due to the lack of data regarding the teratogenic effect of the components of the drug, it is not recommended to use the drug during pregnancy and lactation.

Method of administration and dosage

Adults are prescribed by mouth 1 teaspoon of paste, dissolved in ½ cup of warm sweet water, 3-4 times a day after meals. Course of treatment: the duration of therapy is determined by the doctor. The average course of treatment is 2 weeks to 1.5 months. An increase in the duration of the course of treatment is possible according to the doctor’s prescription.

Side effect

Allergic reactions are possible, sometimes nausea.
With increased sensitivity to ultraviolet rays, photosensitization phenomena are possible.
If side effects occur, the drug should be discontinued.

Release form

Paste for preparation of oral suspension. 100 g in aluminum tubes, lacquered inside. Each tube, together with instructions for use, is placed in a cardboard box.

Storage conditions

At a temperature not higher than 25 ^about C.
Keep out of the reach of children.

Terms of dispensing from pharmacies

Over the counter.

Cystitis after intimacy – causes and treatment

A feature of the inflammatory disease affecting the bladder wall is a tendency to relapse. Cystitis often occurs after intercourse and in some cases the inflammation becomes chronic.[15]

Cystitis after intimacy: causes

In medical practice, there are several reasons for the development of postcoital cystitis. First of all, this is an active sex life. Frequent and rough intercourse leads to injury to the vaginal mucosa, penetration of infection into the submucosa and bloodstream. During intercourse, prolonged massage of the urethra also occurs, which in turn increases the risk of bacteria entering the bladder.[16]

Often, postcoital cystitis occurs due to the anatomical features of the urethra, namely the large width, short length and proximity to the anus, vagina. Cystitis after intercourse can develop for other reasons [17, 18]:

• gynecological diseases that lead to hormonal disorders, inflammation;
• use of spermicides as a method of contraception;
• ectopia of the external opening of the urethra in the vestibule and on the anterior wall of the vagina;
• Increased mobility of the urethra caused by weakness of the external pubo-urethral ligament.

It is important to note that the number of recurrences of cystitis after intimacy increases with increasing intensity of sexual activity (increased frequency of coitus, frequent change of partners) [16]. But on the other hand, after taking a shower, emptying the bladder at the end of intercourse or a single dose of an antibiotic, the incidence of the disease decreases. [17]

How to recognize a disease?

The main symptoms of cystitis in women after sexual intercourse are [18]:

• frequent urination;
• false urge to urinate;
• burning, pain, cramps, discomfort during urination (usually worse by the end of the act).

Usually, there are no signs of an inflammatory process. After the relief of acute attacks of pain, the symptoms subside until the next coitus. Gradually, postcoital cystitis can lead to impaired sexual function, as well as a significant deterioration in the patient’s quality of life. [eighteen]

Cystitis after intimacy: treatment of the disease

The method of treating cystitis in women is taking antibacterial and uro-antiseptic drugs immediately after sex.This tactic is recommended by representatives of the European Association of Urology and in a number of clinical cases it is very effective. [eighteen]

But for most women, this tactic of treatment of cystitis after intimacy is not suitable due to the need for the constant use of antibiotics [18]. Long-term use of them can lead to vaginal dysbiosis, which in turn threatens to increase the risk of developing postcoital cystitis. In addition, antibiotic therapy does not exclude relapse.[15]

In the absence of the effect of drug therapy, the attending physician may consider surgical treatment. The essence of the operation is reduced to the correction of the anatomical position of the external opening of the urethra (movement below the entrance to the vagina). [eighteen]

Paste Fitolysin® – a modern drug for the treatment of cystitis in women

Fitolysin® paste is a medicinal product based on herbal extracts obtained in a high-tech way.It contains a large amount of proanthocyanidins, which are powerful antioxidants and act on pathogens.

Fitolysin® is a paste for the preparation of oral suspension. It is a modern medicine for cystitis. The suspension is better absorbed and delivers active substances to the inflammation focus [2]. The use of herbal preparations has a huge advantage over antibiotics, since bacteria do not develop addiction to herbal ingredients.

Phytolysin® is produced in Europe according to GMP standards [3]. It helps fight the urge to urinate, relieve inflammation, relieve pain and cramps [1]. The active components that make up the drug have an anti-inflammatory, antispasmodic effect. [13]

natural herbal remedy for the improvement of the urinary tract

URONORM ^® – a natural herbal remedy for the improvement of the urinary tract.

Benefits of the composition

• 100% natural composition
• bioactive formula to support the health and protection of the urinary tract
• an optimally balanced combination of precisely selected ingredients – cranberry fruit extract and vitamin C
• two components for the dual benefits of urinary tract diseases – fighting off urinary tract diseases bacteria and antimicrobial protection
• cranberry extract, standardized for the content of proanthocyanidins
• fruits of the North American large-fruited cranberry (Vaccinium Macrocarpon) with maximum ¹ concentration of proanthocyanidins – 900 mg of dry extract of 3625 cranberries and 902 effect of 902 the action of URONORM ^® is due to the properties of the components included in the composition:

  PROANTOCYANIDINS:

  • have antimicrobial properties against E.coli – the main causative agent of urinary tract infections ²
  • prevent the attachment and reproduction of bacteria on the surface of the urinary tract mucosa ² , prevent the formation of biofilms ³
  • promote the elimination of pathogenic bacteria from the urinary tract and urinary bladder 902 902 902 902 902 have a protective effect against infectious and inflammatory phenomena in the urinary system
  • are characterized by the presence of antioxidant properties

  VITAMIN C:

  • helps to suppress the growth and reproduction of microbes (E. coli, Pseudomonas aeruginosa and staphylococcus) in urine ⁴
  • increases the body’s resistance to infections
  • participates in the regulation of redox processes and immune reactions

  Advantages of the form of release

  • convenience of oral administration
  • film coating of the tablet excludes the presence of unpleasant sensory organoleptic sensations when taken – a bitter or sour aftertaste characteristic of cranberries
  • possibility of a single dose per day

  Scope

  • Recommended as a biologically active additive to food – a source of proanthocyanidins and an additional source of vitamin C, which play an important role in increasing the body’s resistance to infections, including urinary tract infections
  • recommendations of the European Urological Association (EAU) contain data on the possibility of prophylactic intake of cranberry fruit extract for cystitis in women with an increased risk of urinary tract infections ⁵

  URONORM ^® , due to the properties of its constituent components, can be included in the daily diet. eating by persons:

  • with an increased risk of developing urinary tract infections
  • in situations most favorable for the development of exacerbations of urinary tract infections (seasonal changes, hot / humid climate, hypothermia, stressful situations, travel, unfavorable hygiene conditions)
  • with frequently recurring episodes of exacerbations of cystitis (more than 3 per year)

  Cranberry extract (PAC) and vitamin C contribute to:

  • enhance antimicrobial protection
  • “consolidate” the results of treatment
  • “insurance” against development and repeated exacerbations

  Study of intravaginal estriol in postmenopausal women with recurrent urinary tract infections

  An estimated 10 to 15 percent of women over 60 years of age have frequent urinary tract infections [1].It is believed that hormone-induced changes in the vaginal flora associated with menopause play an important role in the pathogenesis of urinary tract infections in older women. In premenopausal women, circulating estrogens stimulate the colonization of the vagina by lactobacilli, which produce lactic acid from glycogen and maintain a low vaginal pH that inhibits the growth of many uropathogens [2-3]. However, after menopause, the pH of the vagina increases, lactobacilli disappear from the vaginal flora, and the vagina is predominantly colonized by Enterobacteriaceae, especially Escherichia coli.This colonization appears to partially explain the increased susceptibility of these women to urinary tract infections [4]. Previous studies have shown that replacing estrogen with a topical vaginal cream or oral agent repairs the atrophic mucous membrane of the vagina, urethra; lowers the pH of the vagina; and may reduce the incidence of urinary tract infections. However, only a small number of women participated in the studies, they were not randomized or blind, and none of them had an untreated comparison group.A randomized, double-blind study was conducted to determine whether topical estriol vaginal cream is more effective than placebo cream in reducing the incidence of urinary tract infections in postmenopausal women with recurrent urinary tract infections, and to investigate the effect of local estrogen on the vagina. …

  Flora.

  In the study, women received a tube of their prescribed cream, a vaginal applicator, and a diary that recorded use of the cream, occurrence of side effects, symptoms of urinary tract infection, and use of antibiotics.Throughout the study, they visited the polyclinic on a monthly basis. The diary was reviewed at each visit so that we could assess adherence to treatment. Vaginal pH was measured and vaginal cultures were obtained at study entry and after one and eight months of treatment. Vaginal cultures were obtained by rolling the smear along the lateral wall of the vagina inside the entrance. The swab was immediately inoculated onto agar to isolate aerobic gram-negative bacilli and fresh agar to isolate lactobacilli.Midstream urine samples were also collected at study entry and at each monthly visit during the eight months of follow-up or at the onset of symptoms of urinary tract infection.

  The diagnosis of symptomatic urinary tract infection was based on the presence of typical clinical symptoms (dysuria, frequency, urge to urinate, and urinary incontinence) in addition to laboratory findings for pyuria (at least 8 leukocytes per cubic millimeter of urgent urine) and a midstream urine culture.to obtain ≥ 105 colony forming units (CFU) per milliliter.

  MICROBIOLOGICAL METHODS

  Midstream urine samples were collected and cultured using the Uritest

  system

  Discussion

  Urinary tract infections are an important health problem in postmenopausal women. Although most of these infections remain asymptomatic in these patients, some women experience recurrent episodes of symptomatic infection.Our goal in this study was to determine whether estrogen replacement therapy would reduce the susceptibility of these women to recurrent urinary tract infections and, if so, whether this decrease would be associated with changes in vaginal colonization by lactobacilli. Using a randomized, double-blind, placebo-controlled design and an eight-month follow-up period, we found that topical estrogen treatment had a strong effect on the recurrence rate of urinary tract infection. The significant reduction in the incidence of symptomatic episodes of urinary tract infection in estrogen-treated patients also significantly reduced their antibiotic use.

  The use of topical estrogen has been associated with a significant decrease in vaginal pH, an increase in the rate of vaginal colonization by lactobacilli, and a decrease in the rate of colonization of the vagina by enterobacteria. These changes in colonizing microorganisms undoubtedly play a critical role in changing the susceptibility of postmenopausal women to urinary tract infections. In normal fertile women, lactobacilli species are the predominant microorganisms in the vaginal flora and maintain the usually acidic vaginal pH through their metabolic activity (the formation of lactic acid from carbohydrates).Lactobacilli can protect the vagina from colonization by potential uropathogens through several mechanisms. First, maintaining a low pH itself can have a direct impact. Stamey et al. observed that colonization of the vagina with Escherichia coli rarely occurs at a vaginal pH below 4.5, but is significantly more common in women with recurrent urinary tract infections, many of whom have a vaginal pH above 4.59. Moreover, E. coli strains from serogroups commonly associated with urinary tract infections survive better at lower pH than serogroups not associated with urinary tract infections9.Second, some strains of lactobacilli produce hydrogen peroxide, which can prevent uropathogens from colonizing the vagina. Finally, fragments of lactobacilli cell walls have been shown to prevent E. coli from attaching to epithelial cells, possibly through steric hindrance or by blocking potential attachment sites10. Thus, through one or more of these mechanisms, the loss of colonization of lactobacilli and the associated atrophy of the vaginal mucosa, which usually occurs after menopause, may increase the likelihood of recurrent urinary tract infections.

  The use of a diaphragm with spermicide in premenopausal women who had an increased susceptibility to recurrent urinary tract infections has been associated with increased vaginal pH, decreased lactobacillus colonization, and increased intraital colonization by Enterobacteriaceae.