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BJU International Nov 2022To compare recurrent urinary tract infection (rUTI) guidelines from major urological and non-urological organisations internationally and identify areas of consensus and... (Review)
Review
OBJECTIVE
To compare recurrent urinary tract infection (rUTI) guidelines from major urological and non-urological organisations internationally and identify areas of consensus and discrepancy.
METHODS
PubMed, Google Scholar and the official webpages of major urological, gynaecological, infectious diseases and general practice organisations were searched for rUTI guidelines in March 2022. Nine guidelines were included for review: European Association of Urology, National Institute for Health and Care Excellence (NICE), Society of Obstetricians and Gynaecologists of Canada, American Academy of Family Physicians, Mexican College of Gynaecology and Obstetrics Specialists, Swiss Society of Gynaecology and Obstetrics, Spanish Society of Infectious Diseases and Clinical Microbiology, German Association of Scientific Medical Societies, and the combined American Urological Association/Canadian Urological Association/Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction.
RESULTS
The definition and evaluation of rUTIs, and antibiotic prophylaxis strategies, were mostly consistent across guidelines, and emphasised the importance of obtaining urine cultures and limiting cystoscopy and upper tract imaging in women without risk factors. Variable recommendations were noted for symptomatic treatment, self-initiated antibiotics, and antibiotic-sparing preventative strategies such as cranberry, vaginal oestrogen, immunoactive prophylaxis with OM-89, intravesical glycosaminoglycan instillation, and phytotherapeutics. Recent randomised evidence supports the use of methenamine hippurate. Either continuous or post-coital prophylactic antibiotics were supported by all guidelines. None of the guidelines were tailored to the management recurrent complicated UTI.
CONCLUSION
Multiple rUTI guidelines were identified and mostly limited their recommendations to otherwise healthy non-pregnant women with uncomplicated cystitis. Variation was noted, particularly in antibiotic-sparing preventative strategies. Some conflicting recommendations are due to more recent guidelines including updated evidence. Future guidelines should consider recommendations to assist management of complex patient groups, such as recurrent complicated UTI.
Topics: Pregnancy; Female; Humans; Canada; Urinary Tract Infections; Antibiotic Prophylaxis; Cystitis; Anti-Bacterial Agents
PubMed: 35579121
DOI: 10.1111/bju.15756 -
Nature Reviews. Urology Dec 2018Urinary tract infections (UTIs) are highly prevalent, lead to considerable patient morbidity, incur large financial costs to health-care systems and are one of the most... (Review)
Review
Urinary tract infections (UTIs) are highly prevalent, lead to considerable patient morbidity, incur large financial costs to health-care systems and are one of the most common reasons for antibiotic use worldwide. The growing problem of antimicrobial resistance means that the search for nonantibiotic alternatives for the treatment and prevention of UTI is of critical importance. Potential nonantibiotic measures and treatments for UTIs include behavioural changes, dietary supplementation (such as Chinese herbal medicines and cranberry products), NSAIDs, probiotics, D-mannose, methenamine hippurate, estrogens, intravesical glycosaminoglycans, immunostimulants, vaccines and inoculation with less-pathogenic bacteria. Some of the results of trials of these approaches are promising; however, high-level evidence is required before firm recommendations for their use can be made. A combination of these agents might provide the optimal treatment to reduce recurrent UTI, and trials in specific population groups are required.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Estrogens; Female; Hippurates; Humans; Male; Mannose; Methenamine; Phytotherapy; Probiotics; Recurrence; Secondary Prevention; Urinary Tract Infections
PubMed: 30361493
DOI: 10.1038/s41585-018-0106-x -
BMJ (Clinical Research Ed.) Mar 2022To test and compare the efficacy of methenamine hippurate for prevention of recurrent urinary tract infections with the current standard prophylaxis of daily low dose... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To test and compare the efficacy of methenamine hippurate for prevention of recurrent urinary tract infections with the current standard prophylaxis of daily low dose antibiotics.
DESIGN
Multicentre, open label, randomised, non-inferiority trial.
SETTING
Eight centres in the UK, recruiting from June 2016 to June 2018.
PARTICIPANTS
Women aged ≥18 years with recurrent urinary tract infections, requiring prophylactic treatment.
INTERVENTIONS
Random assignment (1:1, using permuted blocks of variable length via a web based system) to receive antibiotic prophylaxis or methenamine hippurate for 12 months. Treatment allocation was not masked and crossover between arms was allowed.
MAIN OUTCOME MEASURE
Absolute difference in incidence of symptomatic, antibiotic treated, urinary tract infections during treatment. A patient and public involvement group predefined the non-inferiority margin as one episode of urinary tract infection per person year. Analyses performed in a modified intention-to-treat population comprised all participants observed for at least six months.
RESULTS
Participants were randomly assigned to antibiotic prophylaxis (n=120) or methenamine hippurate (n=120). The modified intention-to-treat analysis comprised 205 (85%) participants (antibiotics, n=102 (85%); methenamine hippurate, n=103 (86%)). Incidence of antibiotic treated urinary tract infections during the 12 month treatment period was 0.89 episodes per person year (95% confidence interval 0.65 to 1.12) in the antibiotics group and 1.38 (1.05 to 1.72) in the methenamine hippurate group, with an absolute difference of 0.49 (90% confidence interval 0.15 to 0.84) confirming non-inferiority. Adverse reactions were reported by 34/142 (24%) in the antibiotic group and 35/127 (28%) in the methenamine group and most reactions were mild.
CONCLUSION
Non-antibiotic prophylactic treatment with methenamine hippurate might be appropriate for women with a history of recurrent episodes of urinary tract infections, informed by patient preferences and antibiotic stewardship initiatives, given the demonstration of non-inferiority to daily antibiotic prophylaxis seen in this trial.
TRIAL REGISTRATION
ISRCTN70219762.
Topics: Adolescent; Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Female; Hippurates; Humans; Methenamine; Middle Aged; Recurrence; Treatment Outcome; Urinary Tract Infections; Young Adult
PubMed: 35264408
DOI: 10.1136/bmj-2021-0068229 -
Current Opinion in Urology Nov 2020Urinary tract infections (UTIs) are one of most common infections in everyday clinical practice. Given the increase in antimicrobial therapy resistance, there has been... (Review)
Review
PURPOSE OF REVIEW
Urinary tract infections (UTIs) are one of most common infections in everyday clinical practice. Given the increase in antimicrobial therapy resistance, there has been an increased interest in nonantibiotic treatment options for common infections.
RECENT FINDINGS
A review of the recent literature including on nonantibiotic options for management of UTIs, symptoms of cystitis and prevention of recurrent UTIs.
SUMMARY
The article provides an overview on alternative therapy to antibiotics in the treatment of cystitis and recurrent UTI prophylaxis, including alkalinization of urine, cranberry products, probiotics, NSAIDS, D-mannose, herbal medicine, methenamine hippurate, oral immunostimulants (immunotherapy), topical oestrogens, vitamins and acupuncture. The last few years of intense research has focused on an effort to find evidence to corroborate potentially efficacious non antibiotic treatments. However, alternative treatments for UTIs have not brought conclusive evidence that antibiotic usage can be replaced completely by nonantibiotic options. The reason for this is largely due to a lack of good-quality randomized controlled trials on this subject.
Topics: Anti-Bacterial Agents; Complementary Therapies; Cystitis; Humans; Hydrogen-Ion Concentration; Phytotherapy; Recurrence; Urinary Tract Infections; Urine
PubMed: 33009152
DOI: 10.1097/MOU.0000000000000821 -
Methods in Molecular Biology (Clifton,... 2017The detection of fungal elements and their characterization in patient specimens provides fundamental information. On histological sections fungi are most frequently...
The detection of fungal elements and their characterization in patient specimens provides fundamental information. On histological sections fungi are most frequently seen on skin or mucosal surfaces or as mycotic thrombi or emboli that can occlude both arteries and veins in surgical specimen from immunocompromised patients or tissues obtained from autopsies. Microbial culture continues to be the central method for diagnosing fungal infection but is complemented by histomorphology using specific stains capable of identifying previously unsuspected fungal infections or for evaluating tissue invasion. These stains employ oxidizing reagents to create aldehyde binding sites on polysaccharides (1,2-glycol groups) of fungal cell walls for either Schiff's reagent or Silver ions. Gomori methenamine silver (GMS) and Periodic acid-Schiff (PAS) or their modifications are the most commonly used for tissue sections and in cytology specimens.
Topics: Humans; Mycoses; Staining and Labeling; Tissue Embedding
PubMed: 27837504
DOI: 10.1007/978-1-4939-6515-1_9 -
International Journal of Gynecological... Mar 2019Seven cases of actinomycotic endometritis were identified among 28,906 endometrial biopsies performed in the last 10 yr. The patients' ages ranged from 44 to 85 yr...
Seven cases of actinomycotic endometritis were identified among 28,906 endometrial biopsies performed in the last 10 yr. The patients' ages ranged from 44 to 85 yr old. An intrauterine device was in place from 7 to 44 yr. The reasons to perform the biopsies included abnormal uterine bleeding, malodor, prolapse, pelvic inflammatory disease, and suspicion of metastatic uterine sarcoma. Definitive identification of Actinomyces israelii by culture was obtained in 1 case only. Gram, Gomori methenamine silver, and Fite stains were useful in the differential diagnosis with pseudoactinomycotic granules, Nocardia, fungi, and other bacteria. The Actinomyces-like organisms were surrounded by extensive suppurative reaction in all cases. The tissues showed florid neutrophilic and plasmacytic inflammation. The treatment consisted of intrauterine device removal and 10 to 30 d of antibiotics in 4 patients. The Actinomyces-like organisms persisted for 6 wk in spite of antibiotic therapy when the intrauterine device removal was delayed in one of those cases. Two patients had hysterectomy and salpingo-oophorectomy due to tubo-ovarian abscess and hysterectomy, salpingo-oophorectomy, and rectosigmoid excision due to pelvic abscess and septic emboli, both followed by 30 to 45 d of antibiotic therapy. One patient had hysterectomy not followed by antibiotics due to prolapse. No other pelvic abscesses were identified on follow-up, which ranged from 4 to 101 mo (median, 20 mo; mean, 44 mo).
Topics: Abscess; Actinomyces; Actinomycosis; Adult; Aged; Aged, 80 and over; Diagnosis, Differential; Endometritis; Endometrium; Female; Humans; Intrauterine Devices; Middle Aged; Pelvis
PubMed: 29369919
DOI: 10.1097/PGP.0000000000000476 -
Clinical Microbiology and Infection :... Jun 2017Nitrofurantoin has been used for the prevention of urinary tract infection (UTI) for over 60 years. We conducted a systematic review and meta-analysis to assess its... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Nitrofurantoin has been used for the prevention of urinary tract infection (UTI) for over 60 years. We conducted a systematic review and meta-analysis to assess its efficacy and safety in the prophylaxis of UTI.
METHODS
We performed a systematic review of all controlled trials in humans assessing nitrofurantoin for UTI prophylaxis published from 1946 to 2015. We further reviewed population-level cohort studies evaluating nitrofurantoin's toxicity. Meta-analyses assessing efficacy and adverse events were conducted on controlled trials.
RESULTS
Twenty-six controlled trials including 3052 patients fulfilled entry criteria for the systematic review and meta-analysis on efficacy and toxicity, and 16 population-level cohort studies were identified for review of toxicity. Overall quality was poor, with all studies at increased risk for various biases. When compared with no prophylaxis, nitrofurantoin is effective in the prevention of UTI (risk ratio 0.38 in favour of nitrofurantoin, 95% CI 0.30-0.48). Its prophylactic efficacy is superior to that of methenamine hippurate and comparable to that of other antibacterials. Compared with patients receiving other antibacterials, those receiving nitrofurantoin had an increased risk of 2.24 (95% CI 1.77-2.83) for a non-severe adverse effect. In all controlled trials, only one patient experienced a severe adverse effect (interstitial pneumonia). Cohort studies reported severe adverse effect frequencies of 0.02-1.5 per 1000 nitrofurantoin users.
CONCLUSIONS
Nitrofurantoin is effective in the prevention of UTI. Its use may be associated with increased non-severe adverse effects; severe adverse effects occur infrequently. The risk of severe toxicity seems to increase with the duration of nitrofurantoin prophylaxis.
Topics: Anti-Infective Agents, Urinary; Controlled Clinical Trials as Topic; Female; Humans; Nitrofurantoin; Treatment Outcome; Urinary Tract Infections
PubMed: 27542332
DOI: 10.1016/j.cmi.2016.08.003