Alternative Approaches to Conventional Treatment of Acute Uncomplicated Urinary Tract Infection in Women
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GENITOURINARY INFECTIONS (J SOBEL, SECTION EDITOR)
Alternative Approaches to Conventional Treatment of Acute Uncomplicated Urinary Tract Infection in Women Betsy Foxman & Miatta Buxton
Published online: 2 February 2013 # Springer Science+Business Media New York 2013
Abstract The increasing resistance of uropathogens to antibiotics and recognition of the generally self-limiting nature of uncomplicated urinary tract infection (UTI) suggest that it is time to reconsider empirical treatment of UTI using antibiotics. Identifying new and effective strategies to prevent recurrences and alternative treatment strategies are a high priority. We review the recent literature regarding the effects of functional food products, probiotics, vaccines, and alternative treatments on treating and preventing UTI. Keywords Functional foods . Probiotics . Vaccines . Antiinflammatories
Introduction Especially among sexually active young women aged 18 to 24 years, uncomplicated urinary tract infection (UTI) is extremely common, affecting almost one out of five US women in this age group annually [1]. Even among those experiencing frequent infections, uncomplicated UTI is not associated with loss of renal function or increased mortality (reviewed by Naber et al. [2]). However, the condition causes pain and suffering, and negatively impacts quality of life, albeit transiently [3]. Premenopausal women invariably present with frequent, urgent and painful urination; suprapubic pressure and hematuria may also be present. By contrast, postmenopausal women are more likely to B. Foxman (*) Center for Molecular and Clinical Epidemiology of Infectious Diseases, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA e-mail: [email protected] M. Buxton Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA
present with generalized symptoms, such as lower abdominal pain [4]. Because uncomplicated UTI is generally selflimiting, and responds rapidly to short courses of antibiotic therapy, it is generally treated empirically. There are several reasons to reconsider empirical UTI treatment using antibiotics. First, there is increasing resistance of Escherichia coli, the primary causative agent of uncomplicated UTI, to a variety of antibiotics, including fluoroquinolones [5•], and extended-spectrum beta-lactamase (ESBL) resistance is increasingly observed among communityacquired UTI [6, 7•, 8]. Second, studies of the human microbiota demonstrate there can be significant impact of short courses of antibiotics on the gut microbiota [9]; this probably holds for microbiota in the vaginal cavity and periurethral area where uropathogens also live. If the uropathogen is resistant to the antibiotic, the antibiotic may enhance the pathogenicity of the uropathogen by adversely affecting the inherent pathogen resistance of the normal microbiota. Notably, the most common ESBL-producing E. coli identified to date, denoted by its multilocus sequence type ST131, has few
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