Recurrent Urinary Tract Infections

Recurrent Urinary Tract Infections

GENERALINFORMATION

I.Urinary tract infections (UTI) are caused by bacteria that normally live in the vagina and the rectum. The bacteria migrate into the bladder, which is normally completely free of bacteria.

2.The bacteria that cause most UTIs are not dangerous or toxic.

3.Most UTIs will not cause permanent injury to the bladder or kidneys, no matter how many infections a person gets in a lifetime.

4.UTIs are NOT sexually transmitted diseases, like gonorrhea or syphilis.

5.UTIs are NOT caused by poor hygiene.

6.Douching will increase the risk of developing a UTI. DO NOT DOUCHE!

7.Over 95% of women who get recurrent UTIs have normal urinary tracts, anatomically.

DIAGNOSIS

Most women know when they have a UTI. The most common symptoms include urgency, frequency, burning with urination, and pelvic pain. Some people develop incontinence with infections as well. However, just because a woman has symptoms does not mean that she has an infection.

The diagnosis is made with a urine culture. It can be suspected with a urine analysis, but it must be confirmed with a culture. A voided sample of urine is sent to the laboratory and cultured, It usually takes 2 to 3 days to get a result. The lab will report the type of bacteria, the number of organisms, and the antibiotics that will eliminate the bacteria effectively. The vagina is normally colonized with bacteria, so sometimes is it difficult to obtain a pure specimen that does not include vaginal flora. For this reason, it may be necessary to insert a catheter into the bladder to get a clean specimen.

A full- blown infection will result in 100,000 colony- forming units (CFU) of bacteria. A milder infection, or an incompletely treated infection will result is less than 100,000 CFUs, such as 50,000 or 10,000. The most common type of bacteria that cause urinary tract infections in women is E. Coli.

TREATMENT

A cultured- confirmed UTI must be eradicated with antibiotics. High water intake and cranberry juice may help, but to sterilize the bladder, antibiotics are necessary. Multiple different classes of antibiotics are available on the market. The ~major classes include:

1.Penicillin: Ampicillin/Arnoxicillin for example, These are usually not very effective. The later generations of penicillin, such as Augmentin are good, but they cause GI upset more than other classes of antibiotics. They are also expensive.

2.Cephalosporin: Keflex for example. These are a cousin of penicillin, so patients with penicillin allergies may want to avoid these. There is about a

10% cross reactivity. These are excellent for treating simple UTIs, but some types need to be taken 4 times per day, and they are costly.

3.Sulfa-based antibiotics: Septra and Bactrim, for example. These are some of the oldest antibiotics available, and they work very well. However, patients can develop allergies to them with repeated use. They are inexpensive, effective, and need to be taken only twice a day.

4.Quinolone: Cipro, Levaquin and Noroxin for example. These are excellent antibiotics for any urinary tract disorder. However, they are very strong and will kill bacteria in other parts of the body, such as the vagina, resulting in a yeast infection, and in the GI tract, resulting in diarrhea. They are taken either once or twice per day, and are expensive.

5.Nitrofurantoin: Macrobid and Macrodantin, for example. This is a unique class of antibiotics because these medications do not cause resistant bacteria to grow. Specific for urinary tract infections, they tend not to cause complications, such as yeast infections. They are moderately priced and are taken either twice or four times per day.

For very symptomatic infections or infections that have been untreated for a few days, at least 5 days of medication should be taken. Most physicians recommend a 7 -day course, and some will even prescribe 10 days worth of treatment. The problem with extended treatment is that the bladder can become very irritated from the antibiotics themselves. Some antibiotics are more irritating to the bladder wall than others, and some patients are more sensitive to certain medications than others. Only experience will dictate the best antibiotic for each patient.

After treatment, a follow — up culture should be done to be sure that the infection has been effectively treated. If the colony count comes down to 5,000 CFU that is not a completely treated UTI and a longer course of medication is warranted. Often symptoms will resolve in spite of a low colony count, SD the impression is that the infection has been eradicated. However, a low colony count means that bacteria still live in the bladder and will multiply, resulting in relapsing infection. The follow-up culture should read “no further growth”

PREVENTION

Improved hygiene and abstinence from sexual activity are NOT appropriate preventive measures. Instead, one of two methods of management can be implemented:

I.Self— medication: In an experienced UTI sufferer, this is an excellent method of management. When the symptoms begin, the patient can begin a three — day course of either Nitrofurantoin, Noroxin, or a sulfa based drug. if the symptoms do not resolve, then a physician should be consulted. It is important to keep records of the number of infections that have occurred over each 3-month period.

2.Post-coital Pill: An antibiotic pill is taken within 24 hours of sexual activity. This method works in patients whose infections occur after sexual relations. The same antibiotics as for self-medication can be used.