Recurrent urinary tract infections
Urinary tract infections (UTI) are a relatively common medical problem. 15% of all antibiotic prescriptions are given specifically for urine infections. Some patients, usually female, will have recurrent UTIs, which is defined as 3 episodes or more per year. The possible treatments for recurrent UTIs are outlined below:
Cranberry products
Cranberry products can be taken as juice or tablets and some research studies have shown that it can reduce the rate of urine infections. Both juice and tablets can be bought on the high street and it is thought to work by making the urine more acidic and therefore making it more difficult for bacteria to establish themselves within the urinary system.
Topical oestrogens
Oestrogen is the “female” hormone and has many different effects on various parts of the body. One of the actions of oestrogen is to maintain the vagina in a healthy state. Bacteria from the vagina are often the cause of female UTIs and so oestrogen has been used as a treatment. It is given in the form of a cream or pessary (vaginal tablet) to be used vaginally, especially in post menopausal women. Studies have shown that UTI rates can be reduced by using vaginal oestrogen and it is thought to act by increasing the acidity of the vagina and encouraging changes in the vaginal bacteria.
Probiotics
Probiotics are treatments that encourage high levels of “good” bacteria in the bladder and bowel. This in turn makes it more difficult for the bacteria that cause UTIs to colonise those areas. They have been shown in research studies to reduce the levels of harmful bacteria within the vagina and can be bought from health food stores or online. They are usually given as tablets and the “good” bacteria to look out for when buying probiotics are Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14.
Prophylactic antibiotics
Prophylactic antibiotics are antibiotics that are given in a low dose to be taken daily over an extended period of time (usually 6 months). The low dose is not enough to treat an established infection but is used mainly for prevention of UTIs. Studies have shown impressive reductions in the numbers of UTIs suffered by patients whilst on this treatment. There is a theoretical risk of encouraging the development of resistance to the antibiotics used so the treatment is often limited to 6 months.
Self-start antibiotics
If patients with UTIs have reliable early warning symptoms of urine infections they can be suitable for self-start antibiotic therapy. This involves having a course of antibiotics available at home which can be taken as soon as the patient thinks an infection is about to start. In order to avoid patients taking large amounts of antibiotics this treatment is usually limited to those with reliable predictive symptoms.
Bladder washouts with GAG replacement
The inner lining of the bladder is the first line of defence against urine infections and if damaged, can be the root cause of regular infections. This layer is known as the GAG layer and can be replaced by the instillation of certain chemicals directly into the bladder. This treatment involves the passage of a catheter into the waterpipe (urethra) in order to deliver the GAG replacement substance directly into the bladder. This may cause minor discomfort but a local anaesthetic gel is applied to the entrance of the waterpipe before catheterisation which reduces discomfort. This treatment is often given on a weekly basis for 6-10 weeks and following that a maintenance treatment every few months may be necessary.
Methenamine hippurate
Methenamine is given in tablet form and prevents urine infections as it has an antiseptic (disinfectant) affect on the urinary system. It is taken as a twice daily pill and becomes active within the kidneys to make the urine antiseptic. Methenamine has been shown to reduce UTI rates by up to 80% and is usually given for 6 months.
These treatments all have advantages and disadvantages and prior to considering treatment for recurrent UTIs all patients should have the opportunity to discuss all options with a doctor who has experience in treating this condition. At Newcastle Urology there is a specialist “Recurrent UTI Clinic” which is open to men and women with this problem.
