Update on Urinary Tract Infections

Posted: September 15, 2015

Written by Meghana Gowda, MD, FPMRS

Symptomatic urinary tract infections(UTI) are one of the more common ailments that can plague a woman throughout her lifespan. The incidence of a UTI is 11% per year with a 5% rate of recurrence or relapse. Recurrence is defined as 2 culture confirmed infections within 6 months or 3 within 12 months. Complicated urinary tract infections refer to scenarios of increased risk, including factors such as diabetes, previous urologic surgery, upper tract infection (pyelonephritis), pregnancy, anatomic abnormalities, stone history, or immune suppression. These patients warrant further evaluation which may include imaging, cystoscopy, or cytology. Unfortunately, a large majority of patients will meet one or more criteria for “complicated” infection.

Most uncomplicated urinary tract infections can be managed with a short course of lower dose antibiotics and hydration. According to the 2010 Update by the Infectious Disease Society of America, the recommended first line therapy for uncomplicated UTI is as follows:

  • Nitrofurantoin 100mg bid x 5 days
  • Trimethoprim/sulfamethoxazole 160/800 bid x 3 days
  • Fosfomycin 3 grams, single dose

Recurrent infections can be managed with behavioral modification, topical estrogen cream, cranberry supplementation, and antibiotic prophylaxis versus suppression (if appropriate).  Treatment of stones or obstruction are mandatory if present. We are pleased to offer same day appointments for patients that need to be evaluated and treated for this common and uncomfortable entity.

Pearl of Wisdom: How do cranberries help prevent UTI’s?

Interestingly, the fruit contains tannins called proanthocyanidins, which will reduce E.Coli bacteria adherence to the bladder wall.