Review offers insight into treatment for urinary tract infections

UTIHOUSTON – Because of the rising resistance to antibiotics used to treat urinary tract infections, there are many questions on the appropriate treatment in various populations. Researchers at Baylor College of Medicine and Boston University School of Medicine reviewed current literature on the treatment of urinary tract infections in young healthy women, men and women with diabetes, and their findings were published in the Journal of the American Medical Association.
“Resistance is rising in the organisms that cause UTIs and the clinician increasingly has to consider the individual patient’s risk factors for antibiotic resistant organisms,” said Dr. Barbara Trautner, associate professor of infectious diseases in the departments of medicine and surgery at Baylor and one of the authors of this paper. Trautner is also a researcher with Center for Innovations in Quality, Effectiveness and Safety at the Michael E. DeBakey Veterans Affairs Medical Center in Houston.
Trautner and colleagues reviewed the literature for treatment recommendations for UTIs in young women and found that the original recommendations of first-line antibiotics from the Infectious Disease Society of America still hold true.
They also found that young, healthy women who have at least two symptoms of UTI (painful, urgent or frequent urination) and who do not have vaginal discharge can be treated for UTI without a urine culture or an office visit.
She notes that if women present at the doctor’s office with vague symptoms, or if they have risk factors for complicated UTI or resistant organisms, they need more workup, including a urine culture, to determine if the problem is a UTI or another health concern.
They also found that in males, a shorter duration of therapy of seven days was likely sufficient for UTIs. However, if the patient has clinically significant prostatitis, they may need longer treatment.
Diabetic women have a higher risk for urologic complications, including more recurrent UTIs. However, Trautner and colleagues say that the data shows that each time these women present with a UTI, physicians should manage their treatment the same as the treatment for a young woman without diabetes, unless the woman has known urinary retention or anatomic abnormalities that may create a problem.
Researchers also analyzed the data from placebo trials as well as non-antibiotic treatment trials.
“The data from placebo trials shows that non-treatment is not a good approach,” said Trautner. “In some placebo studies, a small number of women had symptoms that advanced to a kidney infection, which is an undesirable and preventable complication.”
When they reviewed studies involving cranberry products, they found there were no randomized control trials that looked at whether UTIs could be treated with cranberry products. The only trials available were for prevention, and even in these studies, there was no confirmed benefit of cranberry products in preventing UTIs.
Others who took part in this review include Dr. Larissa Grigoryan of Baylor and Dr. Kalpana Gupta of the Boston Veterans Affairs Healthcare System and Boston University School of Medicine.
Funding for this review was made possible by the Houston VA Center for Innovations in Quality, Effectiveness and Safety [CIN13-413] at the Michael E. DeBakey VA Medical Center, Houston, TX (BW Trautner), and National Research Service.