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Alternative Approaches to Conventional Treatment of Acute Uncomplicated Urinary Tract Infection in Women

  • GENITOURINARY INFECTIONS (J SOBEL, SECTION EDITOR)
  • Published:
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Abstract

The increasing resistance of uropathogens to antibiotics and recognition of the generally self-limiting nature of uncomplicated urinary tract infection (UTI) suggest that it is time to reconsider empirical treatment of UTI using antibiotics. Identifying new and effective strategies to prevent recurrences and alternative treatment strategies are a high priority. We review the recent literature regarding the effects of functional food products, probiotics, vaccines, and alternative treatments on treating and preventing UTI.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Foxman B, Brown P. Epidemiology of urinary tract infections: transmission and risk factors, incidence, and costs. Infect Dis Clin North Am. 2003;17:227–41.

    Article  PubMed  Google Scholar 

  2. Naber KG, Wullt B, Wagenlehner FM. Antibiotic treatment of uncomplicated urinary tract infection in premenopausal women. Int J Antimicrob Agents. 2011;38:21–35.

    Article  PubMed  CAS  Google Scholar 

  3. Ellis AK, Verma S. Quality of life in women with urinary tract infections: is benign disease a misnomer. J Am Board Fam Pract. 2002;13:392–7.

    Google Scholar 

  4. Arinzon Z, Shabat S, Peisakh A, Berner Y. Clinical presentation of urinary tract infection (UTI) differs with aging in women. Arch Gerontol Geriatr. 2012;55:145–7.

    Article  PubMed  Google Scholar 

  5. • Hooton TM. Uncomplicated urinary tract infection. N Engl J Med. 2012;366:1028–37. Case vignette and review of treatment of uncomplicated urinary tract infection.

    Article  PubMed  CAS  Google Scholar 

  6. Coque TM, Baquero F, Cantón R. Increasing prevalence of ESBL-producing Enterobacteriaceae in Europe. Euro Surveill. 2008;13(47). pii: 19044.

    Google Scholar 

  7. • Meier S, Weber R, Zbinden R, Ruef C, Hasse B. Extended-spectrum β-lactamase-producing Gram-negative pathogens in community-acquired urinary tract infections: an increasing challenge for antimicrobial therapy. Infection. 2011;39:333–40. Retrospective study comparing community-acquired and healthcare-associated urinary tract infections due to ESBL-producing E. coli.

    Article  PubMed  CAS  Google Scholar 

  8. Fennell J, Vellinga A, Hanahoe B, Morris D, Boyle F, Higgins F, et al. Increasing prevalence of ESBL production among Irish clinical Enterobacteriaceae from 2004 to 2008: an observational study. BMC Infect Dis. 2012;12:116.

    Article  PubMed  Google Scholar 

  9. Dethlefsen L, Huse S, Sogin ML, Relman DA. The pervasive effects of an antibiotic on the human gut microbiota, as revealed by deep 16S rRNA sequencing. PLoS Biol. 2008;6:e280.

    Article  PubMed  Google Scholar 

  10. • Gibreel TM, Dodgson AR, Cheesbrough J, Fox AJ, Bolton FJ, Upton M. Population structure, virulence potential and antibiotic susceptibility of uropathogenic Escherichia coli from northwest England. J Antimicrob Chemother. 2012;67:346–56. Phylogenetic analysis and virulence gene characterization of 300 uropathogenic E. coli.

    Article  PubMed  CAS  Google Scholar 

  11. Oteo J, Perez-Vazquez M, Campos J. Extended-spectrum [beta]-lactamase producing Escherichia coli: changing epidemiology and clinical impact. Curr Opin Infect Dis. 2010;23:320–6.

    Article  PubMed  CAS  Google Scholar 

  12. Chan HL, Stern RS, Arndt KA, Langlois J, Jick SS, Jick H, et al. The incidence of erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis. A population-based study with particular reference to reactions caused by drugs among outpatients. Arch Dermatol. 1990;126(1):43–7.

    Article  PubMed  CAS  Google Scholar 

  13. CIPRO® (ciprofloxacin hydrochloride) tablets, CIPRO® (ciprofloxacin*) oral SUSPENSION [Internet]. Available from: http://www.fda.gov/downloads/Drugs/EmergencyPreparedness/BioterrorismandDrugPreparedness/UCM130802.pdf.

  14. Mehlhorn AJ, Brown DA. Safety concerns with fluoroquinolones. Ann Pharmacother. 2007;41:1859–66.

    Article  PubMed  Google Scholar 

  15. Walbrown MA, Aspinall SL, Bayliss NK, Stone RA, Cunningham F, Squier CL, et al. Evaluation of Clostridium difficile-associated diarrhea with a drug formulary change in preferred fluoroquinolones. J Manag Care Pharm. 2008;14:34–40.

    PubMed  Google Scholar 

  16. Xu J, Schwartz K, Bartoces M, Monsur J, Severson RK, Sobel JD. Effect of antibiotics on vulvovaginal candidiasis: a MetroNet study. J Am Board Fam Med. 2008;21:261–8.

    Article  PubMed  Google Scholar 

  17. Schmiemann G, Kniehl E, Gebhardt K, Matejczyk MM, Hummers-Pradier E. The diagnosis of urinary tract infection: a systematic review. Dtsch Arztebl Int. 2010;107:361–7.

    PubMed  Google Scholar 

  18. Su SB, Wang JN, Lu CW, Guo HR. Reducing urinary tract infections among female clean room workers. J Womens Health (Larchmt). 2006;15:870–6.

    Article  Google Scholar 

  19. Arya LA, Northington GM, Asfaw T, Harvie H, Malykhina A. Evidence of bladder oversensitivity in the absence of an infection in premenopausal women with a history of recurrent urinary tract infections. BJU Int. 2012;110:247–51.

    Article  PubMed  Google Scholar 

  20. Rozin A, Schapira D, Braun-Moscovici Y, Nahir A. Cotrimoxazole treatment for rheumatoid arthritis. Semin Arthritis Rheum. 2001;31:133–41.

    Article  PubMed  CAS  Google Scholar 

  21. • Bleidorn J, Gagyor I, Kochen MM, Wegscheider K, Hummers-Pradier E. Symptomatic treatment (ibuprofen) or antibiotics (ciprofloxacin) for uncomplicated urinary tract infection? –Results of a randomized controlled pilot trial. BMC Med. 2010;8:30. Pilot trial comparing ciprofloxacin to ibuprofen suggesting noninferiority.

    Article  PubMed  Google Scholar 

  22. Christiaens TC, De Meyere M, Verschraegen G, Peersman W, Heytens S, De Maeseneer JM. Randomised controlled trial of nitrofurantoin versus placebo in the treatment of uncomplicated urinary tract infection in adult women. Br J Gen Pract. 2002;52:729–34.

    PubMed  CAS  Google Scholar 

  23. Ferry SA, Holm SE, Stenlund H, Lundholm R, Monsen TJ. The natural course of uncomplicated lower urinary tract infection in women illustrated by a randomized placebo controlled study. Scand J Infect Dis. 2004;36:296–301.

    Article  PubMed  Google Scholar 

  24. Katchman EA, Milo G, Paul M, Christiaaens T, Baerheim A, Leibovici L. Three-day vs longer duration of antibiotic treatment for cystitis in women: systematic review and meta-analysis. Am J Med. 2005;118:1196–207.

    Article  PubMed  CAS  Google Scholar 

  25. Foxman B, Gillespie B, Koopman J, Zhang L, Palin K, Tallman P, et al. Risk factors for second urinary tract infection among college women. Am J Epidemiol. 2000;151:1194–205.

    Article  PubMed  CAS  Google Scholar 

  26. • Brumbaugh AR, Mobley HL. Preventing urinary tract infection: progress toward an effective Escherichia coli vaccine. Expert Rev Vaccines. 2012;11:663–76. Recent comprehensive review of UTI vaccines.

    Article  PubMed  CAS  Google Scholar 

  27. • Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2012;10:CD001321. doi:10.1002/14651858.CD001321.pub5. Metaanalysis of randomized controlled trials assessing cranberry effectiveness in UTI treatment.

    PubMed  Google Scholar 

  28. Harjai K, Kumar R, Singh S. Garlic blocks quorum sensing and attenuates the virulence of Pseudomonas aeruginosa. FEMS Immunol Med Microbiol. 2010;58:161–8.

    Article  PubMed  CAS  Google Scholar 

  29. Albrecht U, Goos KH, Schneider B. A randomised, double-blind, placebo-controlled trial of a herbal medicinal product containing Tropaeoli majoris her-ba (Nasturtium) and Armoraciae rusticanae radix (Horseradish) for the prophylactic treatment of patients with chronically recurrent lower urinary tract infections. Curr Med Res Opin. 2007;23:2415–22.

    Article  PubMed  Google Scholar 

  30. Chung YC, Chen HH, Yeh ML. Vinegar for decreasing catheter-associated bacteriuria in long-term catheterized patients: a randomized controlled trial. Biol Res Nurs. 2012;14:294–301.

    Article  PubMed  Google Scholar 

  31. Peng MM, Fang Y, Hu W, Huang Q. The pharmacological activities of Compound Salvia Plebeia Granules on treating urinary tract infection. J Ethnopharmacol. 2010;129:59–63.

    Article  PubMed  Google Scholar 

  32. Foxman B, Manning S, Tallman P, Bauer R, Zhang L, Koopman J, et al. Uropathogenic Escherichia coli are more likely than commensal E. coli to be shared between heterosexual sex partners. Am J Epidemiol. 2002;158:1133–40.

    Article  Google Scholar 

  33. Schlager TA, Ashe KM, Hendley JO. The ability of periurethral Escherichia coli to grow in a voiding system is a key for the dominance of E. coli cystitis. Microb Pathog. 1997;22:235–40.

    Article  PubMed  CAS  Google Scholar 

  34. Xie J, Foxman B, Zhang L, Marrs CF. Molecular epidemiologic identification of Escherichia coli genes that are potentially involved in movement of organisms from intestinal tract to the vagina and bladder. J Clin Microbiol. 2006;44:2434–41.

    Article  PubMed  CAS  Google Scholar 

  35. Karlsson M, Scherbak N, Khalaf H, Olsson PE, Jass J. Substances released from probiotic Lactobacillus rhamnosus GR-1 potentiate NF-κB activity in Escherichia coli-simulated urinary bladder cells. FEMS Immunol Med Microbiol. 2012;66:147–56.

    Article  PubMed  CAS  Google Scholar 

  36. Stapleton AE, Au-Yeung M, Hooton TM, Fredricks DN, Roberts PL, Czaja CA, et al. Randomized, placebo-controlled phase 2 trial of a Lactobacillus crispatus probiotic given intravaginally for prevention of recurrent urinary tract infection. Clin Infect Dis. 2011;52:1212–7.

    Article  PubMed  Google Scholar 

  37. Beereport MA, ter Riet G, Nys S, van der Wal WM, de Borgie CA, de Reijke TM, et al. Lactobacilli vs antibiotics to prevent urinary tract infections: a randomized, double blind, noninferiority trial in postmenopausal women. Arch Intern Med. 2012;172:704–12.

    Article  Google Scholar 

  38. Trautner BW, Gupta K. The advantages of second best: comment on "Lactobacilli vs antibiotics to prevent urinary tract infections". Arch Intern Med. 2012;172:712–4.

    Article  PubMed  CAS  Google Scholar 

  39. Swidsinski A, Loening-Baucke V, Mendling W, Swidsinski S. Positive effects of local therapy with a vaginal lactic acid gel on dysuria and E. coli bacteriuria question our current views on recurrent cystitis. Arch Gynecol Obstet. 2012;285:1619–25.

    Article  PubMed  Google Scholar 

  40. Lorenzo-Gomez MF, Padilla-Fernandez B, Garcia-Criado FJ, Miron-Canelo JA, Gil-Vicente A, Nieto-Huertos A, et al. Evaluation of a therapeutic vaccine for the prevention of recurrent urinary tract infections versus prophylactic treatment with antibiotics. Int Urogynecol J. 2013;24:127–34.

    Article  PubMed  CAS  Google Scholar 

  41. Bauer HW, Alloussi S, Egger G, Blumlein HM, Cozma G, Schulman CC. A long-term, multicenter, double-blind study of an Escherichia coli extract (OM-89) in female patients with recurrent urinary tract infections. Eur Urol. 2005;47:542–8.

    Article  PubMed  Google Scholar 

  42. • Cai T, Mazzoli S, Mondaini N, Meacci F, Nesi G, D'Elia C, et al. The role of asymptomatic bacteriuria in young women with recurrent urinary tract infections: to treat or not to treat? Clin Infect Dis. 2012;55:771–7. Trial demonstrating increased risk of symptomatic UTI among women with asymptomatic bacteriuria treated with antibiotics.

    Article  PubMed  Google Scholar 

  43. Hansson S, Jodal U, Lincoln K, Svanborg-Eden C. Untreated asymptomatic bacteriuria in girls: II – Effect of phenoxymethylpenicillin and erythromycin given for intercurrent infections. BMJ. 1989;298:856–9.

    Article  PubMed  CAS  Google Scholar 

  44. Sundén F, Håkansson L, Ljunggren E, Wullt B. Escherichia coli 83972 bacteriuria protects against recurrent lower urinary tract infections in patients with incomplete bladder emptying. J Urol. 2010;184:179–85.

    Article  PubMed  Google Scholar 

  45. Hernandez JG, Sunden F, Connolly J, Svanborg C, Wullt B. Genetic control of the variable innate Immune response to asymptomatic bacteriuria. PLoS One. 2011;6:e28289.

    Article  PubMed  CAS  Google Scholar 

  46. Chibeu AA, Lingohr EJE, Masson LL, Manges AA, Harel JJ, Ackermann HW, et al. Bacteriophages with the ability to degrade uropathogenic Escherichia coli biofilms. Viruses. 2012;4:471–87.

    Article  PubMed  CAS  Google Scholar 

  47. Housby JN, Mann NH. Phage therapy. Drug Discovery Today. 2009;14:536–40.

    Article  PubMed  CAS  Google Scholar 

  48. Gagyor I, Hummers-Pradier E, Kochen MM, Schmiemann G, Wegscheider K, Bleidorn J. Immediate versus conditional treatment of uncomplicated urinary tract infection – a randomized-controlled comparative effectiveness study in general practices. BMC Infect Dis. 2012;12:146.

    Article  PubMed  Google Scholar 

  49. Baerheim A. Empirical treatment of uncomplicated cystitis. Scand J Prim Health Care. 2012;30:1–2.

    Article  PubMed  Google Scholar 

  50. eMedExpert. Available from: http://www.emedexpert.com.

  51. Huovinen P, Sundström L, Swedberg G, Sköld O. Trimethoprim and sulfonamide resistance. Antimicrob Agents Chemother. 1995;39:279–89.

    Article  PubMed  CAS  Google Scholar 

  52. Eliopoulos G, Huovinen P. Resistance to trimethoprim sulfamethoxazole. Clin Infect Dis. 2001;32:1608–14.

    Article  Google Scholar 

  53. Skold O. Sulfonamide resistance: mechanisms and trends. Drug Resist Updat. 2000;3:155–60.

    Article  PubMed  CAS  Google Scholar 

  54. Mylan Pharmaceuticals. Morgantown, WV. Available from: http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=2718.

  55. Thomson CJ. The global epidemiology of resistance to ciprofloxacin and the changing nature of antibiotic resistance: a 10 year perspective. J Antimicrob Chemother. 1999;43:31–40.

    Article  PubMed  CAS  Google Scholar 

  56. Mossialos E, Morel CM, Edwards S, Berenson J, Gemmill-Toyama M, Brogan D. Policies and incentives for promoting innovation in antibiotic research. European Observatory on Health Systems and Policies. Available from: http://www.euro.who.int/__data/assets/pdf_file/0011/120143/E94241.pdf.

  57. Bannatyne RM, Toma S, Cheung R, Hu G, Taylor D, Keystone JS, et al. Resistance to trimethoprim and other antibiotics in Ontario Shigellæ. Lancet. 1980;315:425–26.

    Article  Google Scholar 

  58. Kass EH. Chemotherapeutic and antibiotic drugs in the management of infections of the urinary tract. Am J Med. 1955;18:764–81.

    Article  PubMed  CAS  Google Scholar 

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Disclosure

Dr. B. Foxman has been a consultant for Vifor Pharma; M. Buxton reported no potential conflicts of interest relevant to this article.

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Authors and Affiliations

  1. Center for Molecular and Clinical Epidemiology of Infectious Diseases, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, 48109-2029, USA

    Betsy Foxman

  2. Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, 48109-2029, USA

    Miatta Buxton

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  1. Betsy Foxman
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  2. Miatta Buxton
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Correspondence to Betsy Foxman.

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Foxman, B., Buxton, M. Alternative Approaches to Conventional Treatment of Acute Uncomplicated Urinary Tract Infection in Women. Curr Infect Dis Rep 15, 124–129 (2013). https://doi.org/10.1007/s11908-013-0317-5

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