Effectiveness of Estriol-Containing Vaginal Pessaries and Nitrofurantoin Macrocrystal Therapy in the Prevention of Recurrent Urinary Tract Infection in Postmenopausal Women

Abstract

We compared the efficacy and safety of estriol-containing vaginal pessary use with those of oral nitrofurantoin macrocrystal (NM) therapy for preventing urinary tract infection (UTI) in postmenopausal women with recurrent UTI. Over a period of 9 months, 86 women received an estriol-containing vaginal pessary (0.5 mg estriol) twice weekly, and 85 women received NM (100 mg) once daily. We recorded 124 episodes of UTI in women who received estriol-releasing pessaries and 48 episodes of UTI in women treated with NM (P=.0003). Twenty-eight women (32.6%) who received estriol had no episodes of UTI versus 41 women (48.2%) in the NM group. There was a significant increase in the number of superficial cells in women who received estriol, whereas in the NM group, no such changes occurred. However, there was no change in the extent of Lactobacillus colonization and in the vaginal pH in women who received estriol. Use of an estriol-containing pessary is less effective than oral NM therapy in the prevention of bacteriuria in postmenopausal women because of its failure to restore the population of lactobacilli and to reduce the vaginal pH in these women.

Estrogenic Modulation of Uropathogenic Escherichia coli Infection Pathogenesis in a Murine Menopause Model

“…Estrogen has been used widely to treat urinary symptoms in postmenopausal women, but the evidence from randomized studies does not consistently show that estrogen therapy is effective in reducing recurrence of UTIs (20)(21)(22)(23)(24)(25)(26)(27)(28). These inconsistencies may be because the trials used variable dosages and durations of treatment.…”

Rekurentne infekcije mokraćnih puteva: antimikrobna i imunoaktivna profilaksa

“…S druge strane, poređenje efikasnosti vaginalnog pesara sa estriolom i oralne terapije nitrofurantoinom kod žena u postmenopauzi sa rekurentnim infekcijama mokraćnih puteva je pokazalo bolju efikasnost nitrofurantoina. Pesar sa estradiolom nije obnovio populaciju laktobacila niti redukovao vaginalni pH pa nije ni imao povoljno dejstvo [51].…”

Hvordan forebygge residiverende urinveisinfeksjoner etter menopausen?

“…Det er imidlertid ikke presentert noen styrkeberegning, og forskjellene er ikke signifikanstestet. To studier der lokalt østrogen ble sammenliknet med antibiotika (nitrofurantoin, ofloksacin) har gitt motstridende resultater (14,15). Vi har ikke funnet studier der metenamin er sammenliknet med lokalbehandling med østrogen.…”

“…Man kan dermed ikke uten videre gå ut fra at effekten av kontinuerlig antibiotikaprofylakse vil vedvare over tid hos en og samme pasient. Tre måneder etter avsluttet behandling var fortsatt rundt 60 % av isolatene resistente (14). Slike tall bør mane til sterk tilbakeholdenhet med antibiotika som profylakse.…”