This article reviews antibiotic and non-antibiotic treatments for women, to prevent recurrent, uncomplicated urinary tract infections (UTIs), in an outpatient setting. Recurrent UTIs (rUTIs) are costly and increase the emergence of antibiotic resistance, vaginal candidiasis, and Clostridium difficile (C. difficile) infections. They are a painful, expensive, and time-consuming burden to the women affected. Urinary tract infections are treated with antibiotics but many bacteria are becoming resistant to their effects, they have side effects, and their beneficial effects are not sustained. Research for new antibiotics has not been able to match this need. The lack of available, effective antibiotics has led to a search for options: revisiting older, more narrow spectrum antibiotics, non-antibiotic treatments, and alternative medicine treatments. Preventing recurrent UTIs is an especially attractive and potentially effective target.
A number of approaches can be employed immediately in an outpatient setting. General advice, emphasizing the need to increase water, symptomatic treatment with a ‘wait and see approach’ are good first steps. It is reasonable to check and correct Vitamin D status, and if postmenopausal, discuss topical estrogen. Patients who are motivated and have a history of rUTIs might benefit from cranberry extract, (not juice), including with propolis, lactobacilli, methenamine, d-mannose, flavonoids, and herbal mixtures as possible prophylaxis for a recurrent UTI.
Clinical trials of new treatments and especially vaccines, may offer future options for prevention. New studies will continue to elucidate the complex pathophysiology of infection and resistance.
Hoar S. Strategies to prevent recurrent urinary tract infections in women in the age of antibiotic resistance. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2019; 1(4).
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