Recurrent UTI Flashcards
(29 cards)
definition recurrent UTI
recurrences of complicated or uncomplicated
at least 3 in a year
or two UTI in last 6 months
prevalence rUTI in young women
20-50% with UTI will have another one within a year
risk of UTI in women in lifetime
50%
prevelence of rUTI
30% of those with one uti will have rUTI
Lawrentshuk 2006 flexi
van haarst urology 2001
8% had abnormalities on cystoscopy
NPV of imaging was 99%
so no cystoscopy in women with no risk factors and normal imaging
Van haarst 2001
100 women less than 40, 1% abnormal imaging, 22% abnormal cystoscopy - never relevant
imaging in rUTI
US beneficial in women Franco 2005 best practice clinic obs gynae
non pharm management
D mannose cranberry tablets topical vaginal oestrogens methenamine hippurate vaccines
cranberry products
Jurol 2017 28 trials SR RR 32% Luis evidence probably helps no conclusion on formulation avoid if on warfarin
vaginal oestrogen cream
Raz and stamm
estriol cream 0.5mg applied topically night 2 weeks then twice weekly for 8 months reduced rUTI 16% vs 62% NNT 2-4 NEJM 1992 Raz and Stamm
D mannose
SR
dose
action mechanism
rct non blinded
dose 2g superior placebo and as effective as nitro
SR Kyriakides 2020
inhibits bacterial adherence to urothelial cells
methanamine hippurate
trial
mechanism
converted to formaldehyde in acidid urine environment directly toxic ALTAR trial results compared abx - Forbes, Chris Harding hipprex is non inferior less costly new first line option
dose hipprex
1g every 12 hours
in catheters
1g every 8-12 hours
dose hipprex
1g every 12 hours
in catheters
1g every 8-12 hours
CI to hipprex
gout
metabolic acidosis
severe dehydration
CI to hipprex
gout
metabolic acidosis
severe dehydration
vaccines
name recommended by EAU
what is it
UroVaxom is only one recommended EAU
immunologically active bacterial lysates of 18 ecoli strains
also Urovac
and UROMUNE
cochrane review of prophylactic abx
RR 0.21 for single recurrence NNT 1.85 but RR after completion prophylaxis is 0.82
cochrane review of prophylactic abx
RR 0.21 for single recurrence NNT 1.85 but RR after completion prophylaxis is 0.82
cure rate self start abx
> 09 Hooton NEJm 2012
principle of intravesical treatment
glycosaminoglycan hyaluronic acid HA and chrondroitin sulphate CS used to enhance protective function urothelium
intravesical agents
cystistat HA
hyacyst HA
gepan CS
iAluril HA and CS
SR of intravesical
De Vita
decreased cystitis recurrence, UTI recurrenc enad pelvic pain
action of cranberries
containing compound
how they act against ecoli
Prophylaxis with cranberries is a potential prevention strategy with
health benefits associated with the high concentrations of polyphenols such as PACs proanthocyanidins in these berries.
PACs are stable phenolics with antiadhesion activity against E. coli.
They act as receptor analogues and inhibit E. coli adhesion to cells by binding to the fimbrial tips
dose of cranberry products
Stothers described 2
ways of orally administering cranberry products,
that is tablets of concentrated cranberry juice and
pure unsweetened cranberry juice.
Wing et al administered 2 doses of PACs, including a high dose (240 mg PACs per day) and a low dose (80 mg PACS per day).
