Urinary alkalisation for symptomatic uncomplicated urinary tract infection in women

O‘Kane, Dermot; Dave, Sameer; Gore, Neel; Patel, Farhaan; Hoffmann, Tammy; Trill, Jeanne; Mar, Chris Del

doi:10.1002/14651858.cd010745.pub2

Cited by 15 publications

(16 citation statements)

References 20 publications

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“…A Cochrane meta-analysis found multiple trials adopting urinary alkalinization as a method to avoid urinary infection. Nonetheless, none of those trials reached a significant conclusion to adopt such therapy[24]Another preventive therapy proposed is utilizing Lactobacillus probiotics. The rationale is the formation of vaginal barrier to pathogenic bacteria.…”

Section: Nonantimicrobial Therapymentioning

confidence: 99%

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Management of urinary tract infection in women: A practical approach for everyday practice

et al. 2019

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A common health-care problem worldwide, urinary tract infection (UTI), represents a disease of significant impact on every country's economy, being the most common cause of hospitalization among elderly people and the most common cause of antibiotic prescription in primary care. Diagnosing and managing upper and lower UTI have always been a challenge to physicians, given its high prevalence, risk of recurrence and improper treatment, and the fact of worldwide increase in antibiotic resistance, necessitating implementation of a proper antibiotic stewardship. Urinary infections are twice more likely to occur in females compared to males and its prevalence increases with increasing age. The following is a comprehensive review paper about UTI in females, discussing the various factors leading to a complicated infection. The various etiologies and microbiologies of UTI are also highlighted. In addition to various usual antibiotic regimens for treating UTI, a significant number of nonantimicrobial treatment modalities are highlighted and described in this manuscript, including the novel use of intravesical antibiotics and vaccines for suppression treatment. Finally, a pathway is suggested for the proper diagnosis and treatment that ensures antibiotic stewardship in order to decrease long-term complications.

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Section: Nonantimicrobial Therapymentioning

confidence: 99%

Section: Nonantimicrobial Therapymentioning

confidence: 99%

Management of urinary tract infection in women: A practical approach for everyday practice

et al. 2019

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“…The doctors may not have considered this option, as it does not feature in the Malaysian guideline [29], or maybe it seemed impractical since patients collect their prescription from the attached pharmacy on the day. Symptomatic treatment was extensively used, though we note that for alkalinisers there is insufficient evidence to support their use [35].…”

Section: Discussionmentioning

confidence: 93%

Pitfalls in diagnosis and management of suspected urinary tract infection in an urban tropical primary care setting

Jackson

Lai

Alias

et al. 2019

J Infect Dev Ctries

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Introduction: Diagnosis and management of urinary tract infection (UTI) are complex, and do not always follow guidelines. The aim of this study was to determine adherence to the 2014 Malaysian Ministry of Health guidelines for managing suspected UTI in a Malaysian primary care setting. Methodology: We retrospectively reviewed computerized medical records of adults with suspected UTI between July-December 2016. Excluded were consultations misclassified by the search engine, duplicated records of the same patient, consultations for follow-up of suspected UTI, patients who were pregnant, catheterised, or who had a renal transplant. Records were reviewed by two primary care physicians and a clinical microbiologist. Results: From 852 records, 366 consultations were a fresh episode of possible UTI. Most subjects were female (78.2%) with median age of 61.5 years. The major co-morbidities were hypertension (37.1%), prostatic enlargement in males (35.5%) and impaired renal function (31.1%). Symptoms were reported in 349 (95.4%) consultations. Antibiotics were prescribed in 307 (83.9%) consultations, which was appropriate in 227/307 (73.9%), where the subject had at least one symptom, and leucocytes were raised in urine full examination and microscopic examination (UFEME). In 73 (23.8%) consultations antibiotics were prescribed inappropriately, as the subjects were asymptomatic (14,4.6%), urine was clear (17,5.5%), or UFEME did not show raised leucocytes (42,13.7%). In 7 (2.3%) consultations appropriateness of antibiotics could not be determined as UFEME was not available. Conclusion: Several pitfalls contributed to suboptimal adherence to guidelines for diagnosis and management of suspected UTI. This illustrates the complexity of managing suspected UTI in older subjects with multiple co-morbidities.

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“…The UK antimicrobial resistance strategy and action plan states that “the emergence of resistance represents adaptive selection by microorganisms, which is an inevitable result of therapeutic use of antimicrobial agents.” As a result there is a demand from patients and clinicians alike to explore nonantibiotic alternatives for the prevention of rUTI . Several Cochrane meta‐analyses have been published pertaining to nonantibiotic options and these include urinary alkalinisation, probiotics, Chinese herbal medicine, methenamine hippurate, cranberries and oestrogens . Although for most treatments the quality of evidence was low both methenamine hippurate (relative risk [RR] = 0.24) and vaginal oestrogens (RR = 0.25) were shown to significantly reduce infection rates.…”

Section: Nonantibiotic Options For Ruti Preventionmentioning

confidence: 99%

How can we improve investigation, prevention and treatment for recurrent urinary tract infections – ICI‐RS 2018

Harding

Rantell

Cardozo

et al. 2019

Neurourology and Urodynamics

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Background: Recurrent urinary tract infection (rUTI) is a chronic conditionand has a significant impact on health-related quality of life. The commonly used definition for rUTI is greater than three episodes in a year or more than two in 6 months. Current diagnostic methods have been used worldwide for over five decades, despite well evidenced criticism. Enhanced culture techniques demonstrate that the microbiome of the bladder is far more complex than previously thought and begs a reappraisal of our current testing. Treatment of rUTI is based on a small number of antibiotic trials with some evidence showing a reduction in the number of positive cultures, but one must be cautious in interpreting the results and weigh against the risk of generation of antimicrobial resistance (AMR).Aim: The International Consultation on Incontinence-Research Society think tank reviewed the literature with a view to improving investigation, prevention and treatment of rUTI. Methods: A multidisciplinary team of experts were invited to present evidence regarding the current diagnostic methods, recent advances related to bladder biome mapping and current treatment strategies, including antibiotic and nonantibiotic options. Current guidelines regarding antibiotic stewardship and concerns regarding AMR were discussed. Discussion: Outcome of the think tank discussions are summarised with a set of recommendations to inform future research. Particular consideration is given to bacterial survival in the bladder after treatment as well as defects in urothelial barrier function which may play a significant part in the failure to eradicate UTI. K E Y W O R D S antimicrobial resistance, urinary tract infection Neurourology and Urodynamics. 2019;38:S90-S97. wileyonlinelibrary.com/journal/nau S90 |

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Urinary alkalisation for symptomatic uncomplicated urinary tract infection in women

Abstract: Until relevant evidence is generated from randomised trials, the safety and efficacy of urinary alkalisers for the symptomatic treatment of uncomplicated UTI remains unknown.

Cited by 15 publications

References 20 publications

Management of urinary tract infection in women: A practical approach for everyday practice

Management of urinary tract infection in women: A practical approach for everyday practice

Pitfalls in diagnosis and management of suspected urinary tract infection in an urban tropical primary care setting

How can we improve investigation, prevention and treatment for recurrent urinary tract infections – ICI‐RS 2018

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