Guideline of guidelines: management of recurrent urinary tract infections in women

Kwok, Michael; McGeorge, Stephen; Mayer-Coverdale, Johanna; Graves, Bianca; Paterson, David L.; Harris, Patrick N A; Esler, Rachel; Dowling, Caroline; Britton, Sumudu; Roberts, Matthew J.

doi:10.1111/bju.15756

Cited by 60 publications

(81 citation statements)

References 52 publications

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“…Non-antibiotic preventative strategies include the use of cranberry products, despite the low compliance rate among patients, probiotics, phytotherapeutics, or immunotherapies, such as OM-89, which is a bacterial extract from E. coli that stimulates the host immune system to produce cytokines and antibodies against several bacteria species due to sharing similar antigenic structures. Vaginal estrogen, methenamine hippurate and replenishment of the glycosaminoglycan (GAG) layers within the bladder urothelium to reduce bacterial adherence, have also been recommended in order to reduce UTIs recurrence but with variable results [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Intestinal Permeability and Dysbiosis in Female Patients with Recurrent Cystitis: A Pilot Study

Graziani

Laterza

Talocco

et al. 2022

JPM

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Recurrent cystitis (RC) is a common disease, especially in females. Anatomical, behavioral and genetic predisposing factors are associated with the ascending retrograde route, which often causes bladder infections. RC seems to be mainly caused by agents derived from the intestinal microbiota, and most frequently by Escherichia coli. Intestinal contiguity contributes to the etiopathogenesis of RC and an alteration in intestinal permeability could have a major role in RC. The aim of this pilot study is to assess gut microbiome dysbiosis and intestinal permeability in female patients with RC. Patients with RC (n = 16) were enrolled and compared with healthy female subjects (n = 15) and patients with chronic gastrointestinal (GI) disorders (n = 238). We calculated the Acute Cystitis Symptom Score/Urinary Tract Infection Symptom Assessment (ACSS/UTISA) and Gastrointestinal Symptom Rating Scale (GSRS) scores and evaluated intestinal permeability and the fecal microbiome in the first two cohorts. Patients with RC showed an increased prevalence of gastrointestinal symptoms compared with healthy controls. Of the patients with RC, 88% showed an increased intestinal permeability with reduced biodiversity of gut microbiota compared to healthy controls, and 68% of the RC patients had a final diagnosis of gastrointestinal disease. Similarly, GI patients reported a higher incidence of urinary symptoms with a diagnosis of RC in 20%. Gut barrier impairment seems to play a major role in the pathogenesis of RC. Further studies are necessary to elucidate the role of microbiota and intestinal permeability in urinary tract infections.

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Section: Discussionmentioning

confidence: 99%

Intestinal Permeability and Dysbiosis in Female Patients with Recurrent Cystitis: A Pilot Study

Graziani

Laterza

Talocco

et al. 2022

JPM

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“…3,8,9 Nearly all guidelines previously mentioned made a weak recommendation for implementing behavioral modifications. 10 Regardless of the strength of evidence, it is acceptable to implement these modifications as no harm can be done to the individual. 9 The use of cranberry for UTI prevention has been recommended for decades despite the lack of supporting data.…”

Section: Nonpharmacologicmentioning

confidence: 99%

When urinary tract infections keep coming back

Roloff¹

2023

WHC

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“…[23][24][25] The lack of conclusive evidence is manifested as an absence of clear official guidelines for initiation and duration of prophylactic treatment with methenamine hippurate. 26 Evaluation of treatment duration is especially challenging in the older population, often leading to prolonged or life-long treatment. Recent years' progression of AMR has led to a growing interest in exploring methenamine hippurate as a preventive alternative for recurrent UTIs.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…However, non-antibiotic treatment options for UTIs like methenamine hippurate have not yet yielded conclusive evidence of effect 23–25. The lack of conclusive evidence is manifested as an absence of clear official guidelines for initiation and duration of prophylactic treatment with methenamine hippurate 26. Evaluation of treatment duration is especially challenging in the older population, often leading to prolonged or life-long treatment.…”

Section: Introductionmentioning

confidence: 99%

Methenamine hippurate to prevent recurrent urinary tract infections in older women: protocol for a randomised, placebo-controlled trial (ImpresU)

et al. 2022

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IntroductionMethenamine hippurate is a urinary antiseptic used as preventive treatment for recurrent urinary tract infections (UTIs) in some Scandinavian countries. However, the scientific evidence for the preventive effect and safety for longer-term use is limited. The aim of this study is to assess whether methenamine hippurate can reduce the incidence of UTIs in older women with recurrent UTIs.Methods and analysisThe ImpresU consortium is a collaboration between Norway, Sweden, Poland and the Netherlands. The study is a randomised, controlled, triple-blind phase IV clinical trial. Women ≥70 years with recurrent UTIs are screened for eligibility in a general practice setting. We aim to include 400 women in total, with 100 recruited from each collaborating country. The participants are randomised to treatment with methenamine hippurate 1 g or placebo tablets two times per day for a treatment period of 6 months, followed by a drug-free follow-up period of 6 months. The primary outcome is number of antibiotic treatments for UTIs during the treatment period. The secondary outcomes include number of antibiotic treatments for UTIs during the follow-up period and self-reported symptom of severity and duration of UTI episodes. Differences in complications between the treatment groups are measured as safety outcomes. We also aim to investigate whether strain characteristics or phylogenetic subgroups ofEscherichia colipresent in the urine culture at inclusion have a modifying effect on the outcomes.Ethics and disseminationEthical approvals are obtained in all participating countries. The results will be communicated in peer-reviewed journals and at scientific conferences.Trial registration numberClinicalTrials.gov Registry (NCT04077580); EudraCT: 2018-002235-15.

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Guideline of guidelines: management of recurrent urinary tract infections in women

Cited by 60 publications

References 52 publications

Intestinal Permeability and Dysbiosis in Female Patients with Recurrent Cystitis: A Pilot Study

Intestinal Permeability and Dysbiosis in Female Patients with Recurrent Cystitis: A Pilot Study

When urinary tract infections keep coming back

Methenamine hippurate to prevent recurrent urinary tract infections in older women: protocol for a randomised, placebo-controlled trial (ImpresU)

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