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Prophylaxis for Recurrent Urinary Tract Infections

All the organs that collect, store, and release urine constitute the urinary tract. According to the National Institute of Diabetes and Digestive and Kidney Diseases, urinary tract infections (UTIs) are the second most common type of infection in humans. Men commonly get repeat infections, while about 20 to 25% of affected women experience recurrent infections within a year.

  1. Types

    • Depending on where they occur in the urinary tract, urinary tract infections (UTIs) are either upper or lower. Infections of the urethra (urethritis) or bladder (cystitis) are generally classified as lower UTIs, while kidney infections (pyelonephritis) are considered upper UTIs.

    Causes

    • Some viruses, fungi and parasites can cause UTIs. However, more than 85% of cases result from bacteria in the intestine or vagina. E.coli is the most common cause of lower urinary tract infection. Organisms enter the urinary tract through its lower end are normally washed out as the bladder empties. If this does not occur properly, these organisms can ascend the urinary tract, to cause disease. Bacteria can also enter the urinary tract through the bloodstream.

    Risk Factors

    • The three main risk factors for UTIs are: an increased frequency of sexual intercourse; the use of a spermicide and diaphragm, and the loss of estrogen's effect in the vagina and the structures surrounding the urethra. Additional risk factors for urinary tract infection include: obstruction from any cause, HIV infection, diabetes, fecal or urinary incontinence, and use of catheters.

    Lifestyle/Behavioral Measures

    • Lifestyle-related prophylaxis (prevention) for recurrent UTIs include: proper hygiene, condom usage; urge-initiated voiding, voiding after sexual intercourse, increased fluid intake, daily consumption of cranberry juice or vitamin C, avoiding spermicides, wearing cotton underwear and loose-fitting clothes, and self-initiated antibiotics. Additionally, teach children to wipe themselves from front to back after a bowel movement and also to avoid frequent bubble baths. Circumcision of boys also lowers the risk of UTIs during infancy.

    Medical Prophylaxis

    • A more aggressive prophylactic regimen for recurrent UTIs may include using an effective antimicrobial after sexual intercourse. When recurrent UTIs have non-modifiable causes, or carry a risk of complication, continuous antimicrobial prophylaxis (prolonged preventative measures to kill bacteria) is often indicated. Some antimicrobial (bacteria-killing) medications that are used are: TMP-SMZ, nitrofurantoin, norfloxacin, and trimethoprim.

    Other Prophylaxis

    • Postmenopausal women with recurrent urinary tract infections can benefit from estrogen replacement. Estriol, for instance, is a vaginal cream can lower the incidence of recurrent UTIs.

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