Essay regarding Recurrent Uti

SOGC CLINICAL PRACTICE GUIDELINE

SOGC MEDICAL PRACTICE GUIDELINE

No . two hundred fifity, November 2010

Recurrent Urinary Tract Infection

Abstract

This kind of Clinical Practice Guideline continues to be prepared by the Urogynaecology Committee, reviewed by the Family Medical professionals Advisory Panel, and given the green light by the Executive and Authorities of the Culture of Obstetricians and Gynaecologists of Canada. PRINCIPAL EXPERTS Annette Epp, MD, Saskatoon realtor SK Annick Larochelle, MD, St . Lambert QC UROGYNAECOLOGY COMMITTEE Danny Lovatsis, MD (Chair), Toronto ON Jens-Erik Walter, MARYLAND (Co-Chair), Westmount QC Bill Easton, MD, Scarborough ABOUT Annette Epp, MD, Saskatoon realtor SK Jeff A. Farrell, MD, Halifax NS Lise Girouard, RN, Winnipeg MB Chander Gupta, MD, Winnipeg MB Marie-AndrГ©e Harvey, MARYLAND, Kingston IN Annick Larochelle, MD, St Lambert QC Magali Robert, MD, Calgary AB File suit Ross, PhD, Calgary STOMACH Joyce Schachter, MD, Ottawa ON Jane A. Schulz, MD, Edmonton AB David Wilkie, MD, Vancouver BC FAMILY MEDICAL PROFESSIONALS ADVISORY PANEL William Ehman, MD (Chair), Naniamo BC Sharon Domb, MD, Barcelone ON AndrГ©e Gagnon, MD, Blainville QC Owen Barnes, MD, Ottawa ON Jill Konkin, MD, Edmonton STOMACH Joanna Lynch, MD, Winnipeg MB Cindy Marshall, MARYLAND, Lower Sackville NS Disclosure statements have been completely received coming from all users of the committees. The literary works searches and bibliographic support for this standard were taken on by Becky Skidmore, Medical Research Expert, Society of Obstetricians and Gynaecologists of Canada. Target: To provide an update of the classification, epidemiology, medical presentation, investigation, treatment, and prevention of recurrent urinary tract attacks in ladies. Options: Ongoing antibiotic prophylaxis, post-coital antibiotic prophylaxis, and acute self-treatment are all effective alternatives in order to avoid recurrent urinary tract contamination. Vaginal estrogen and cranberry juice may also be effective prophylaxis alternatives. Evidence: A search of PubMed as well as the Cochrane Selection for content published in English discovered the most relevant literature. Results were restricted to methodical reviews, randomized control trials/controlled clinical trials, and observational studies. There were zero date restrictions. Values: This kind of update may be the consensus of the Sub-Committee upon Urogynaecology in the Society of Obstetricians and Gynaecologists of Canada. Advice were made in line with the guidelines produced by the Canadian Task Force on Precautionary Health Care (Table 1). Choices: Recurrent urinary tract infections need cautious investigation and can be efficiently treated and averted. Different prophylaxis options could be selected relating to each person's characteristics. Advice 1 . Urinalysis and before your done urine lifestyle and tenderness should be performed with the first presentation of symptoms to be able to establish a accurate diagnosis of persistent urinary system infection. (III-L) 2 . People with persistent hematuria or persistent growth of bacteria besides Escherichia coli should undergo cystoscopy and imaging from the upper urinary tract. (III-L) 3. Sexually active women suffering from repeated urinary tract infections and using spermicide should be encouraged to consider an alternative sort of contraception. (II-2B) 4. Prophylaxis for recurrent urinary system infection ought not to be undertaken until a negative culture 1 to 2 weeks after treatment has proved eradication in the urinary tract infection. (III-L) 5. Constant daily antibiotic prophylaxis using cotrimoxazole, nitrofurantoin, cephalexin, trimethoprim, trimethoprimsulfamethoxazole, or possibly a quinolone throughout a 6- to 12-month period should be agreed to women with Ві a couple of urinary system infections in 6 months or Ві three or more urinary system infections in 12 months. (I-A) 6. Females with repeated urinary system infection linked to sexual intercourse needs to be offered post-coital prophylaxis rather than continuous remedy in order to minimize cost and side effects. (I-A)

Key Words:...

References: 1 . Czaja CA, Hooton TM. Bring up to date on acute uncomplicated urinary tract disease in girls. Postgrad Mediterranean 2006; 119: 39–45. 2 . Foxman B, Barlow R, D'Arcy H, Gillespie B, Sobel JD. Self reported incidence of urinary tract infection and associated costs. Ann Epidemiol 2000; 10: 509–15. three or more. Hooton TM. A potential study for risk elements for symptomatic urinary system infection in young girls. N Engl J Scientif 1996; 335: 468. some. Jackson SL, Boyko IJ, Scholes D, Abraham T, Gupta K, Fihn SD. Predictors of urinary tract infection following menopause. I am J Mediterranean sea 2004; 117: 903. your five. Gopal M, Northington G, Arya L. Clinical symptoms predictive of recurrent urinary tract infection. Am J Obstet Gynecol 2007; 197: 74. e1–4. 6. Engender RT Sr. Uncomplicated urinary tract attacks in girls. Obstet Gynecol Clin North Am 08; 35: 235–48. 7. American College of Obstetricians and Gynecologists. Take care of urinary system infection in non women that are pregnant. ACOG Practice Bulletin Number 91, Mar 2008. Obstet Gynecol 2008; 11: 785–94. 8. Hooton. Recurrent urinary tract contamination in females. Int T Antimicrobial Brokers 2001; 18: 259–268. 9. Kraft JK, Stamey TAG. The natural history of systematic recurrent bacteruria in ladies. Medicine 1977; 56: 55–60. 10. Gupta K, Stamm WE. Pathogenesis and supervision of recurrent urinary tract infecitons in women. World J Urol 1999; seventeen: 415–20. 11. Foxman N, Gillespie M, Koopman M, Zhang T, Palin K, Tallman G, et 's. Risk fctors for second urinary tract infection among college girls. Am T Epidemiol 2150; 151: 1194–205. 12. Curled S, Nallamothu BK, Simel DL, Fihn SD, Saint S. Does this woman come with an acute urinary tract illness? JAMA 2002; 287: 2701–10. 13. Gupta K, Hooton TM, Roberts PL Baumstamm WE. Patient-initiated treatment of repeated urinary system infection in women. Ann Intern Med 2001; one hundred thirty five: 9–16. 13. Echols RM, Tosiello RL, Haverstock POWER, Tice ADVERTISEMENT. Demographic, specialized medical and treatment parameters affecting the outcome of acute cystitis. Clin Assail Dis 99; 29: 113–9. 15. Mulvey MA, Schilling JD, Jultgren SJ. Establishment of a consistent Escherichia coli reservoir throughout the acute stage of a bladder infection. Contaminate Immun 2001; 69: 4572–9. 16. Rosen DA, Hooten TM, Baumstamm WE, Humphrey PA, Hultgren SJ. Detection of intracellular bacterial residential areas in human being urinary system infection. PLOS Med 2007; 4: e329. 17. Fihn SD. Serious uncomplicated urinary tract contamination in females. N Engl J Scientif 2003; 349: 259–66. 18. Johnson JUNIOR, Clabots C. Sharing of virulent Escherichia coli imitations among family members of a female with severe cystitis. Clin Infect Dis 2006; 43: e101–8. 19. Gupta T, Stapleton STRYGE, Hooton TM, Roberts PL, Fennell CRAIGSLIST, Stamm WE ALL. Inverse affiliation of H202-producing Lactobacilli and vaginal At the. coli colonization in females with persistent urinary system infection. J Infect Dis 1998; a hundred and seventy-eight: 446–50. 20. Scholes M, Hooton TM, Roberts PL, Stapleton D?GGE, Gupta T, Stamm WE. Risk factors for persistent urinary system infection in young women. J Contaminate Dis 2000; 182: 1177–82.

21. Minardi D, Parri G, d'Anzeo G, Fabiani A, Este Asmar Unces, Muzzonigro G. Perineal ultrasound evaluation of dysfunctional urinating in women with persistent urinary system infections. L Urol 2008; 179: 947–51. 22. Car J, Sheikh A. Persistent urinary system infection in women. BMJ 2003: 327: 1204. twenty-three. Car T. Urinary tract infections in women: diagnosis and supervision in major care. BMJ 2006; 332: 94–7. twenty four. Lifshitz Elizabeth, Kramer T. Outpatient urine culture. Will collection strategy matter? Posture Intern Scientif 2000; 160: 2537–40. twenty-five. Simerville JA, Maxted WC, Pahira JJ. Urinalysis: a comprehensive review. Are Fam Medical professional 2005; 71: 1153–62. twenty six. Drekonja DM, Johnson JUNIOR. Urinary system infections. Prim Care 2008; 35: 345–67. 27. Hooton TM, Baumstamm WE. Analysis and take care of uncomplicated urinary tract contamination. Infect Dis Clin North Am 1997; 11: 551–81. 28. Gupta K, Scholes D, Stamm WE. Elevating prevalence of antimicrobial amount of resistance among uropathogens causing severe uncomplicated cystitis. J Are Med Assoc 1999; 281: 736–8. 29. Warren JW, Abrutyn Elizabeth, Hebel JR, Johnson JR, Schaeffer AJ, Stamm WE. Guidelines intended for antimicrobial treatment of uncomplicated acute bacterial cystitis and severe pyelonephritis in women. Clignement Infect Dis 1999; 30: 745–58. 30. Wright SW, Wrenn IN PIECES, Haynes ML. Trimethoprim-sulfamethoxazole level of resistance among urinary coliform isolates. J Style Intern Med 1999; 14: 606–9. thirty-one. Gupta K, Hooton TM, Roberts MS, Stamm ALL OF US. Short-course nitrofurantoin for the treating acute easy cystitis in women. Posture Intern Scientif 2007; 167(20): 2207–12. thirty-two. Franco AV. Recurrent urinary tract infections. Best Pract Res Clignement Obstet Gynaecol 2005; nineteen: 861–73. thirty-three. Reid G. Potential precautionary strategies and therapies in urinary tract infection. Universe J Urol 1999; 18: 359–63. 34. Hooton TM, Stamm WE ALL. Urinary tract infections and asymptomatic bacteriuria in being pregnant. UpToDate 08; version of sixteen. 2 (May 31, 2008). 35. Albert X, Huertas I, PereirГі II, San fГ©lix L, Gosalbes Versus, Perrota C. Antibiotics intended for preventing persistent urinary tract infection in nonpregnant females. Cochrane Databases Syst Add some opuch 2004; (3): CD001209. 36. Stapleton A, Stamm WE. Prevention of urinary tract infection. Contaminate Dis Clignement North I am 1997; 10: 719–33. thirty seven. Orenstein 3rd there’s r, Wong SERA. Urinary tract infections in adults. Am Fam Physician 1999; 59(5): 1225–34, 1237. 35. Dwyer PL, O'Reilly M. Recurrent urinary tract contamination in the feminine. Curr Opin Obstet Gynecol 2002; 14: 537–43. 39. Nicolle VOTRE. Urinary system infection: traditional pharmacologic solutions. Am M Med 2002; 113(Suppl 1A): 35S-44S. forty five. Guibert T, Humbert G, Meyrier A, Jardin A, Vallancien G, Piccoli T et ing. Antibioprevention of recurrent cystitis. A randomized double-blind comparison trial of 2 dosages of pefloxacin. Tvinge Med 1995; 24: 213–6. 41. Melekos MD, Asbach HW, Gerharz E, Zarakovitis IE, Weingaertner K, Naber KG. Post-intercourse versus daily ciprofloxacin prophylaxis for recurrent urinary tract infections in premenopausal females. J Urol 1997; 157: 935–9. 40. Engel JD, Schaeffer AJ. Evaluation of and anti-bacterial therapy to get recurrent urinary tract infections in ladies. Urol Clignement North Are 1998; twenty-five: 685–701. 43. Stapleton A, Latham RH, Johnson C, Stamm WE. Postcoital anti-bacterial prophylaxis to get recurrent urinary tract infection. A randomized, double-blind, placebo-controlled trial. JAMA 1990; 264: 703–6.

NOVEMBER JOGC NOVEMBRE 2010 d 1089

SOGC CLINICAL PRACTICE GUIDELINE

44. Stamm WE ALL, Counts GW, Wagner K, Martine M, Gregory G, McKevitt M, et ing. Antimicrobial prophylaxis of recurrent urinary system infections: a double-blind, placebo-controlled trial. Ann Intern Mediterranean 1980; 80: 770–5. 45. Nicolle LE. Prophylaxis: repeated urinary system infections in women. Infection 1992; 20(Suppl 3): S203–5. 46. Zhanel GG, Nicolle LE. Associated with sub-inhibitory antimicrobial concentration (sub-MICs) on in-vitro bacterial faithfulness to uroepithelial cells. T Antimicrob Chemother 1992; up to 29: 617–27. 47. Goemaere NNT, Grijm T, ThW truck Hal G, Bakker MOTHER. Nitrofurantoin-induced pulmonary fibrosis: a case-report. T Med Case Report 08; 2: 169. 48. Nicolle LE, Harding GK, Thomson M, Kennedy J, Urias B, Ronald AR. Effectiveness of five season of continuous, low-dose trimethoprim-sulfamethoxazole prophylaxis for urinary tract infection. L Infect Dis 1988; 157: 1239–42. forty-nine. Schaeffer AJ, Jones JM, Flynn DURE. Prophylactic efficacy of cinoxacin in recurrent urinary system infection: biologic effects for the vaginal and fecal bacteria. J Urol 1982; 127: 1128–31. 55. Cardozo M, Lose G, McClish D, Versi Electronic, de Koning Gans H. A systematic overview of estrogens intended for recurrent urinary tract infections: third statement of the human hormones and urogenital therapy (HUT) committee. Int Urogynecol T Pelvic Floor Dysfunct 2001; 12: 15–20. fifty-one. Perrotta C, Aznar M, Mejia L, Albert Back button, Ng CW. Oestrogens for preventing persistent urinary system infection in postmenopausal women. Cochrane Data source Syst Revolution 2008; (2): CD005131. 52. Raz L, Stamm WE ALL. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract attacks. New Engl J Med 1993; 329: 753–6. 53. Eriksen BC. A randomized, open, parallel-group study around the preventive a result of an estradiol-releasing vaginal engagement ring (Estring) on recurrent urinary tract attacks in postmenopausal women. Am J Obstet Gynecol 1999; 180: 1072–9. 54. Raz R. Junk replacement therapy or prophylaxis in postmenopausal women with recurrent urinary tract disease. J Invade Dis 2001; 183(Suppl 1): S74–6. fifty five. Raz L, Colodner 3rd there’s r, Rohana Y, Battino S i9000, Rottensterich E, Wasser We, et al. Effectiveness of estriol-containing penile pessaries and nitrofurantoin macrocrystal therapy inside the prevention of recurrent urinary tract contamination in postmenopausal women. Clin Infect Dis 2003; thirty eight: 1362–8. 56. Xu L, Wu Y, Hu Y. Prevention and treatment of recurrent urinary system infection with estrogen cream in postmenopausal women. Zhonghua Fu Chan Ke Za Zhi 2001; 36: 531–3. 57. Schmidt DR, Sobota AE. An examination of the antiadherence activity of cranberry drink on urinary and non-urinary bacterial isolates. Microbios 1988; 55: 173–81. 58. Zafriri D, Ofek I, Adar R, Pocino M, Sharon N. Inhibitory activity of craberry juice on adherence of type you and type P fimbriated Escherichia coli to eucaryotic cells. Antimicrob Agents Chemother 1989; thirty-three: 92–8. fifty nine. Jepson JP, Craig JC. Cranberries pertaining to preventing urinary tract attacks. Cochrane Repository Syst Rev 2008; (1): CD 001321. 60. Kontiokari T, Sundqvist K, Nuutinen M, Pokka T, Koskela M, Uhari M. Randomised trial of cranberry-lingonberry drink and Lactobacillus GG drink for the prevention of urinary tract infections in women. BMJ 2001; 322(7302): 1571–3. 61. McMurdo ME, Bissett IALLY, Price RJ, Phillips G, Crombie IK. Does intake of cranberry juice reduce symptomatic urinary tract infections in seniors in clinic? A double-blind, placebo-controlled trial. Age Getting older 2005; 34: 256–61. sixty two. Stothers L. A randomized trial to judge effectiveness and cost effectiveness of naturopathic cranberry extract products while prophylaxis against urinary tract infection in women. Can J Urol 2002; 9: 1558–62.

63. Waites KILOBYTES, Canupp KC, Armstrong S, DeVivo MJ. Effect of cranberry extract extract about bacteriuria and pyuria in persons with neurogenic urinary secondary to spinal cord injury. J Spine Med 2004; 27: 35–40. 64. Aune A, Alreak T, LiHua H, Baerheim A. Acupuncture therapy in the prophylaxis of persistent lower urinary tract disease in adult women. Scand J Prim Health Care 98; 16: 37–9. 65. Alraek T, Fagerheim U, Baerheim A. Acupuncture treatment in the prevention of uncomplicated repeated lower urinary tract infections in adult women. Was J Public well-being 2002; ninety two: 1609–11. 66. Reid G, Bruce AW :. Probiotics in order to avoid urinary tract infections: the rational and evidence. Universe J Urol 2006; 24: 28–32. 67. Reid G, Bruce RE:, Taylor M. Instillation of Lactobacillus and stimulation of indigenous organisms to prevent recurrence of urinary tract attacks. Microecol Ther 1995; 3: 32–45. 68. Uehara T, Monden T, Nomoto T, Seno Con, Kariyama L, Kumon L. A pilot study assessing the safety and effectiveness of Lactobacillus vaginal suppositories in patients with recurrent urinary tract infection. Int T Antimicrob Providers 2006; 28(Suppl 1): S30–4. 69. Baerheim A, Larsen E, Digranes A. Penile application of lactobacilli in the prophylaxis of repeated urinary tract infection in women. Scand J Prim Health Care 1994; 12: 239–43. 70. Falagas ME, Betsi GI, Tokas T, Athanasiou S. Probiotics for elimination of repeated urinary tract infections in women. Drugs 2006; sixty six: 1253–61. 71. Grischke NA, RГјttgers H. Treatment of microbe infections of the female urinary tract by immunization of the patiets. Urol Int 1987; forty two: 338–41. 72. Uehling DT, Hopkins WJ, Beierle LM, Kryger JV, Heisey DM. Vaginal mucosal immunization pertaining to recurrent urinary tract disease: extended stage II specialized medical trial. M Infect Dis 2001; 183 (Suppl 1): S81–3. 73. Hopkins WJ, Uehling DT. Vaccine advancement for preventing urinary tract infections. Curr Infect Dis Rep 2002; 4: 509–13. 74. SundГ©n F, HГҐkansson L, Ljunggren E, Wullt B. Bacterial interference—is strategic colonization with Escherichia coli 83972 an alternative solution treatment for patients with recurrent urinary tract infection? Int T Antimicrob Agents 2006; 28(Suppl 1): S26–9. 75. Lipovac M, Kurz C, Reithmayr F, Verhoeven HC, Huber JC, Imhof M. Reduction of persistent bacterial urinary tract attacks by intravesical instillation of hyaluronic chemical p. Int L Gynaecol Obstet 2007; 96: 192–5. 76. Constantinides C, Manousakas Big t, Nikolopoulos G, Stanitsas A, Haritopoulos K, Giannopoulos A. Prevention of recurrent bacterial cystitis by simply intravesical administration of hyaluronic acid: a pilot research. BJU Int 2004; 93: 1262–6. 77. Eden CS, Fretr Ur, Hagberg M, Hull R, Hull T, Leffler L, et al. Inhibition of experimental climbing urinary tract infection simply by an epithelial cell-surface receptor analogue. Nature 1982; 298(5874): 560–2. 79. Zopf M, Roth T. Oligosaccharides anti-infectives agents. Lancet 1996; 347(9007): 1017–21. 79. Romero 3rd there’s r, Oyarzun Elizabeth, Mazor M, Sirtori M, Hobbins JC, Bracken Meters. Meta-analysis with the relationship between asymptomatic bacteriuria and preterm delivery/low labor and birth weight. Obstet Gynecol 1989; 73: 576–82. 80. Pfau A, Bags TG. Powerful prophylaxis to get recurrent urinary tract infections during pregnancy. Clin Infect Dis 1992; 18: 810–4. 81. Ovalle A, Levancini M. Urinary tract infections in pregnancy. Curr Opin Urol 2001: 11: 55–9. 82. Woolf YOU WILL NEED, Battista REGISTERED NURSE, Angerson GENERAL MOTORS, Logan AG, Eel W. Canadian Process Force on Preventive Healthcare. New grades for recommendations from the Canadian Task Push on Preventive Health Care. CMAJ 2003; 169: 207–8.

1090 l THE FALL OF JOGC NOVEMBRE 2010