UTI treatment and prevention

Urinary tract infection (UTI) is common among men and women. Most UTIs are caused from ascending infection beginning in the urethra and migrating up to the bladder. Baylor Medicine urologist Dr. Christopher Smith explains how to effectively manage and prevent this condition.

A UTI is usually associated with symptoms of dysuria, or burning with urination, as well as urinary frequency or urgency. Doctors usually advise patients with mild symptoms to increase fluid intake, take AZO or other over-the-counter medications for symptom relief and ibuprofen if experiencing pain. However, if the symptoms are severe or do not improve, a visit to the doctor, including urine collection, is advised to determine whether an infection exists and which bacteria is responsible for the infection.

“As urologists, we recommend most patients get a culture before starting prescription treatment so we can see what we’re dealing with and make sure we’re treating it appropriately,” said Smith, associate professor in the Scott Department of Urology at Baylor College of Medicine.

Treatment typically consists of a course of antibiotics. Smith emphasizes that specialists try to use as short of a course as possible, aiming for a three-to-five-day course and not exceeding seven days of antibiotic use.

“One of the concerns we have treating patients is that we really want to be good stewards and not overtreat. If we treat with antibiotics for too much time, especially for undocumented infections, it can lead to antibiotic resistance, which can be a problem,” Smith said.

Some patients might have asymptomatic bacteria where they do not display symptoms of a UTI but show bacteria in a urine specimen. Asymptomatic patients do not typically require treatment.

A persistent infection requires a repeated culture to see if the infection has cleared. If not, a specialist will make sure the correct antibiotic is chosen and might recommend more evaluation and imaging to make sure there is not an anatomic reason for the UTI to persist.

“Some patients may be misdiagnosed with a bacterial infection when they actually are suffering from a condition of chronic bladder inflammation like interstitial cystitis, a condition that can mimic all the symptoms of a UTI except the urine culture will be negative. These patients will be mistreated with antibiotics,” Smith said. “Obtaining urine cultures with each episode is important because we shouldn’t just treat based on symptoms.”

While both men and women can contract UTIs, women’s anatomy makes them more prone to infection due to the shorter urethra. Sixty percent of women will have one episode of acute symptomatic UTI in their lifetime; 20 to 40% of those women will have more than one episode, and 20 to 50% of that population will have multiple episodes. A recurrent UTI entails two documented UTIs within six months or three UTIS within 12 months. Patients with recurrent UTIs should see a urologist.

The best treatment is prevention. Smith details his triple defense strategy to prevent UTIs:

• Probiotics: organisms that cause the UTI are often located in the gut, so probiotics can help flush out the bad bacteria and replace it with healthy, normal flora.
• Hormonal cream: the vaginal flora of bacteria should function as a protective barrier against pathogenic UTI causing bacteria. In perimenopausal or postmenopausal women, there can be a change within the vaginal flora that can allow harmful bacteria to colonize these tissues and be one step closer to invading the urethra and bladder. Topical application of hormone cream can help restore that protective flora within the vaginal tissue.
• Cranberry supplement: this supplement has known properties that show it can prevent bacterial adhesion to bladder tissues and subsequent infection. However, not all cranberry supplements are equally effective in bacterial anti-adhesive properties.

In addition to the triple defense strategy, hydration also is key for the body to flush out bacteria. If the recurrent UTI does not improve with this strategy, patients may require taking a low dose, daily suppressive antibiotic.

Some groups could face higher risk contracting UTIs. Patients who are immunocompromised and on immunosuppressant therapy are more prone to infection. Diabetic patients could also be more prone, especially if they are on medication that cause urinary excretion of glucose. Patients with indwelling or intermittent catheters as well as those with anatomic abnormalities are more susceptible to UTI. Patients with a history of urinary sepsis could be at risk for future septic episode and should be evaluated by a urologist and monitored closely.

By Homa Warren