genitourinary disorders
Bacterial Urinary Tract Infections
Prevention of Bacterial UTIs
In women with recurrent urinary tract infection (UTI), physical examination should include pelvic examination to detect manageable conditions, such as vulvovaginal atrophy, urethral diverticulum, Fecal Incontinence , and In women who experience≥3 urinary tract infections (UTIs)/year, behavioral measures are recommended, including increasing fluid intake, avoiding spermicides and diaphragm use, not delaying urination, wiping front to back after defecation, avoiding douching, and urinating immediately after sexual intercourse. If these techniques are unsuccessful, antibiotic prophylaxis should be considered. Common options are continuous and postcoital prophylaxis. The use of Cranberry products, in addition to other behavioral measures, may be considered another strategy to prevent recurrent cystitis. This approach is based on evidence suggesting that 30 ml/min ( Prevention references ). Postcoital prophylaxisin women may be more effective if UTIs are temporally related to sexual intercourse. Usually, a single dose of one of the antibiotics used for continuous prophylaxis (other thanfosfomycin) is effective. Contraceptionis recommended for women using a fluoroquinolone because these medications can potentially injure a fetus. Although concern exists that antibiotics may decrease the effectiveness of oral contraceptives, pharmacokinetic studies have not shown a significant or consistent effect. Nonetheless, some experts still recommend that women who use oral contraceptives use barrier contraceptives while they are taking antibiotics. Inpregnant women, effective prophylaxis of UTI is similar to that in nonpregnant women, including use of postcoital prophylaxis. Appropriate patients include those with acute pyelonephritis during a pregnancy, patients with>1 episode (despite treatment) of UTI or bacteriuria during pregnancy, and patients who required prophylaxis for recurrent UTI before pregnancy. Inpostmenopausal women, antibiotic prophylaxis is similar to that described previously. Additionally, topical estrogen therapy markedly reduces the incidence of recurrent UTI in women with atrophic vaginitis or atrophic urethritis. 1.Jepson RG, Williams G, Craig JC: Cranberries for preventing urinary tract infections.Cochrane Database Syst Rev10(10);CD001321, 2012. doi: 10.1002/14651858.CD001321.pub5 2.Chwa A, Kavanagh K, Linnebur ASA, et al: Evaluation ofmethenaminefor urinary tract infection prevention in older adults: A review of the evidence.Ther Adv Drug Saf2019. v.10. doi: 10.1177/2042098619876749 