Korean J Urogenit Tract Infect Inflamm.  2014 Apr;9(1):1-8. 10.14777/kjutii.2014.9.1.1.

Antimicrobial Prophylaxis for Recurrent Urinary Tract Infection

• Park MG
• Cho DY

• KMID: 1921569
• DOI: http://doi.org/10.14777/kjutii.2014.9.1.1

Abstract

Recurrent uncomplicated urinary tract infection (UTI) is a common problem in women, causing considerable morbidity and expense, and is a management burden for clinicians. In management of recurrent UTI, non-antimicrobial approaches to prevention of UTI, such as behavioral modifications should first be tried as a way of minimizing antimicrobial exposure, however, antimicrobial treatment of prophylaxis may be necessary in those who continue to have recurrences. Continuous antimicrobial prophylaxis, post-coital prophylaxis with low dose antimicrobials, and intermittent self-treatment with antimicrobials have all been shown to be effective in prevention of recurrent uncomplicated UTIs. The decision regarding which approach to use for prophylaxis depends on the frequency and pattern of recurrence and the patient's preference to commit to a specific method. The risk of adverse events and the plan for pregnancy should be considered before starting any regimen of antimicrobial prophylaxis. The susceptibility of the organisms causing the previous UTIs and history of the patient's drug allergies should be considered before selection of antimicrobials. Before initiation of any prophylaxis regimen, eradication of a previous UTI should be confirmed by a negative urine culture. Continuous antimicrobial prophylaxis is usually used for long periods, thus likely contributing to the widespread problem of antimicrobial resistance. Post-coital prophylaxis and self-treatment approach result in less antimicrobial use, but should be used in the appropriate settings.

Keyword

Recurrence; Urinary tract infections; Antibiotics; Antibiotic prophylaxis

MeSH Terms

Anti-Bacterial Agents
Antibiotic Prophylaxis
Drug Hypersensitivity
Female
Humans
Pregnancy
Recurrence
Urinary Tract Infections*
Anti-Bacterial Agents

Reference

1. Foxman B. Recurring urinary tract infection: incidence and risk factors. Am J Public Health. 1990; 80:331–3.

2. Foxman B, Gillespie B, Koopman J, Zhang L, Palin K, Tallman P, et al. Risk factors for second urinary tract infection among college women. Am J Epidemiol. 2000; 151:1194–205.

3. Ikäheimo R, Siitonen A, Heiskanen T, Kärkkäinen U, Kuosmanen P, Lipponen P, et al. Recurrence of urinary tract infection in a primary care setting: analysis of a 1-year followup of 179 women. Clin Infect Dis. 1996; 22:91–9.

4. Kim ME. Recurrent cystitis. Korean J Urogenit Tract Infect Inflamm. 2010; 5:134–42.

5. Pfau A, Sacks T, Engelstein D. Recurrent urinary tract infections in premenopausal women: prophylaxis based on an understanding of the pathogenesis. J Urol. 1983; 129:1153–7.

6. Scholes D, Hooton TM, Roberts PL, Stapleton AE, Gupta K, Stamm WE. Risk factors for recurrent urinary tract infection in young women. J Infect Dis. 2000; 182:1177–82.

7. Scholes D, Hawn TR, Roberts PL, Li SS, Stapleton AE, Zhao LP, et al. Family history and risk of recurrent cystitis and pyelonephritis in women. J Urol. 2010; 184:564–9.

8. Raz R, Gennesin Y, Wasser J, Stoler Z, Rosenfeld S, Rottensterich E, et al. Recurrent urinary tract infections in postmenopausal women. Clin Infect Dis. 2000; 30:152–6.

9. Lichtenberger P, Hooton TM. Antimicrobial prophylaxis in women with recurrent urinary tract infections. Int J Antimicrob Agents. 2011; 38(Suppl):36–41.

10. Stamm WE. Estrogens and urinary-tract infection. J Infect Dis. 2007; 195:623–4.

11. Mulvey MA, Schilling JD, Martinez JJ, Hultgren SJ. Bad bugs and beleaguered bladders: interplay between uropathogenic Escherichia coli and innate host defenses. Proc Natl Acad Sci U S A. 2000; 97:8829–35.

12. Rosen DA, Hooton TM, Stamm WE, Humphrey PA, Hultgren SJ. Detection of intracellular bacterial communities in human urinary tract infection. PLoS Med. 2007; 4:e329.

13. Cardozo L, Lose G, McClish D, Versi E, de Koning Gans H. A systematic review of estrogens for recurrent urinary tract infections: third report of the hormones and urogenital therapy (HUT) committee. Int Urogynecol J Pelvic Floor Dysfunct. 2001; 12:15–20.

14. Perrotta C, Aznar M, Mejia R, Albert X, Ng CW. Oestrogens for preventing recurrent urinary tract infection in postmenopausal women. Cochrane Database Syst Rev. 2008; 2:CD005131.

15. Albert X, Huertas I, Pereiró II, Sanfélix J, Gosalbes V, Perrota C. Antibiotics for preventing recurrent urinary tract infection in non-pregnant women. Cochrane Database Syst Rev. 2004; 3:CD001209.

16. Rudenko N, Dorofeyev A. Prevention of recurrent lower urinary tract infections by longterm administration of fosfomycin trometamol. Double blind, randomized, parallel group, placebo controlled study. Arzneimittelforschung. 2005; 55:420–7.

17. Nicolle LE, Harding GK, Thomson M, Kennedy J, Urias B, Ronald AR. Efficacy of five years of continuous, low-dose trimethoprim-sulfamethoxazole prophylaxis for urinary tract infection. J Infect Dis. 1988; 157:1239–42.

18. Brumfitt W, Hamilton-Miller JM. Efficacy and safety profile of longterm nitrofurantoin in urinary infections: 18 years' experience. J Antimicrob Chemother. 1998; 42:363–71.

19. Yoon H. Guidelines on the management of acute uncomplicated cystitis and recurrent urinary tract infections in women. Korean J Urogenit Tract Infect Inflamm. 2008; 3:264–75.

20. Kraft JK, Stamey TA. The natural history of symptomatic recurrent bacteriuria in women. Medicine (Baltimore). 1977; 56:55–60.

21. Stamm WE, McKevitt M, Roberts PL, White NJ. Natural history of recurrent urinary tract infections in women. Rev Infect Dis. 1991; 13:77–84.

22. Nicolle LE, Ronald AR. Recurrent urinary tract infection in adult women: diagnosis and treatment. Infect Dis Clin North Am. 1987; 1:793–806.

23. Harding GK, Ronald AR, Nicolle LE, Thomson MJ, Gray GJ. Longterm antimicrobial prophylaxis for recurrent urinary tract infection in women. Rev Infect Dis. 1982; 4:438–43.

24. Chew LD, Fihn SD. Recurrent cystitis in nonpregnant women. West J Med. 1999; 170:274–7.

25. Epp A, Larochelle A, Lovatsis D, Walter JE, Easton W, Farrell SA, et al. Recurrent urinary tract infection. J Obstet Gynaecol Can. 2010; 32:1082–101.

26. Pfau A, Sacks TG. Effective prophylaxis of recurrent urinary tract infections in premenopausal women by postcoital administration of cephalexin. J Urol. 1989; 142:1276–8.

27. Pfau A, Sacks TG. Effective postcoital quinolone prophylaxis of recurrent urinary tract infections in women. J Urol. 1994; 152:136–8.

28. Pfau A, Sacks TG. Effective prophylaxis for recurrent urinary tract infections during pregnancy. Clin Infect Dis. 1992; 14:810–4.

29. Nicolle LE, Harding GK, Thompson M, Kennedy J, Urias B, Ronald AR. Prospective, randomized, placebo-controlled trial of norfloxacin for the prophylaxis of recurrent urinary tract infection in women. Antimicrob Agents Chemother. 1989; 33:1032–5.

30. Stapleton A, Latham RH, Johnson C, Stamm WE. Postcoital antimicrobial prophylaxis for recurrent urinary tract infection. A randomized, double-blind, placebo-controlled trial. JAMA. 1990; 264:703–6.

31. Melekos MD, Asbach HW, Gerharz E, Zarakovitis IE, Weingaertner K, Naber KG. Post-intercourse versus daily ciprofloxacin prophylaxis for recurrent urinary tract infections in premenopausal women. J Urol. 1997; 157:935–9.

32. Wong ES, McKevitt M, Running K, Counts GW, Turck M, Stamm WE. Management of recurrent urinary tract infections with patient-administered single-dose therapy. Ann Intern Med. 1985; 102:302–7.

33. Schaeffer AJ, Stuppy BA. Efficacy and safety of self-start therapy in women with recurrent urinary tract infections. J Urol. 1999; 161:207–11.

34. Mazzei T, Cassetta MI, Fallani S, Arrigucci S, Novelli A. Pharmacokinetic and pharmacodynamic aspects of antimicrobial agents for the treatment of uncomplicated urinary tract infections. Int J Antimicrob Agents. 2006; 28(Suppl 1):S35–41.

35. Gupta K, Sahm DF, Mayfield D, Stamm WE. Antimicrobial resistance among uropathogens that cause community-acquired urinary tract infections in women: a nationwide analysis. Clin Infect Dis. 2001; 33:89–94.

36. Sahm DF, Thornsberry C, Mayfield DC, Jones ME, Karlowsky JA. Multidrug-resistant urinary tract isolates of Escherichia coli: prevalence and patient demographics in the United States in 2000. Antimicrob Agents Chemother. 2001; 45:1402–6.

37. Fadda G, Nicoletti G, Schito GC, Tempera G. Antimicrobial susceptibility patterns of contemporary pathogens from uncomplicated urinary tract infections isolated in a multicenter Italian survey: possible impact on guidelines. J Chemother. 2005; 17:251–7.

38. Owens RC Jr, Ambrose PG. Torsades de pointes associated with fluoroquinolones. Pharmacotherapy. 2002; 22:663–8. discussion 668-72.

39. Sode J, Obel N, Hallas J, Lassen A. Use of fluroquinolone and risk of Achilles tendon rupture: a population-based cohort study. Eur J Clin Pharmacol. 2007; 63:499–503.

40. van der Linden PD, Sturkenboom MC, Herings RM, Leufkens HG, Stricker BH. Fluoroquinolones and risk of Achilles tendon disorders: case-control study. BMJ. 2002; 324:1306–7.

41. Corrao G, Zambon A, Bertù L, Mauri A, Paleari V, Rossi C, et al. Evidence of tendinitis provoked by fluoroquinolone treatment: a case-control study. Drug Saf. 2006; 29:889–96.

42. Giamarellou H, Kolokythas E, Petrikkos G, Gazis J, Aravantinos D, Sfikakis P. Pharmacokinetics of three newer quinolones in pregnant and lactating women. Am J Med. 1989; 87:49S–51S.

43. Hooton TM, Winter C, Tiu F, Stamm WE. Randomized comparative trial and cost analysis of 3-day antimicrobial regimens for treatment of acute cystitis in women. JAMA. 1995; 273:41–5.

44. Brumfitt W, Hamilton-Miller JM. A comparative trial of low dose cefaclor and macrocrystalline nitrofurantoin in the prevention of recurrent urinary tract infection. Infection. 1995; 23:98–102.

45. Gower PE. The use of small doses of cephalexin (125 mg) in the management of recurrent urinary tract infection in women. J Antimicrob Chemother. 1975; 1(3 Suppl):93–8.

46. Kahlmeter G. Prevalence and antimicrobial susceptibility of pathogens in uncomplicated cystitis in Europe. The ECO.SENS study. Int J Antimicrob Agents. 2003; 22(Suppl 2):49–52.

47. Falagas ME, Giannopoulou KP, Kokolakis GN, Rafailidis PI. Fosfomycin: use beyond urinary tract and gastrointestinal infections. Clin Infect Dis. 2008; 46:1069–77.

48. Patel SS, Balfour JA, Bryson HM. Fosfomycin tromethamine. A review of its antibacterial activity, pharmacokinetic properties and therapeutic efficacy as a single-dose oral treatment for acute uncomplicated lower urinary tract infections. Drugs. 1997; 53:637–56.

49. Schito GC, Naber KG, Botto H, Palou J, Mazzei T, Gualco L, et al. The ARESC study: an international survey on the antimicrobial resistance of pathogens involved in uncomplicated urinary tract infections. Int J Antimicrob Agents. 2009; 34:407–13.

50. Hayashi K. Other antibiotics. Clin Orthop Relat Res. 1984. 109–13.

51. Arca P, Reguera G, Hardisson C. Plasmid-encoded fosfomycin resistance in bacteria isolated from the urinary tract in a multicentre survey. J Antimicrob Chemother. 1997; 40:393–9.

52. Alós JI, García-Peña P, Tamayo J. Biological cost associated with fosfomycin resistance in Escherichia coli isolates from urinary tract infections. Rev Esp Quimioter. 2007; 20:211–5.

53. Kahlmeter G, Menday P. Cross-resistance and associated resistance in 2478 Escherichia coli isolates from the Pan-European ECO.SENS Project surveying the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections. J Antimicrob Chemother. 2003; 52:128–31.

54. Nicolle LE. Prophylaxis: recurrent urinary tract infection in women. Infection. 1992; 20(Suppl 3):S203–5. discussion S206-10.

55. Barbut F, Richard A, Hamadi K, Chomette V, Burghoffer B, Petit JC. Epidemiology of recurrences or reinfections of Clostridium difficile-associated diarrhea. J Clin Microbiol. 2000; 38:2386–8.

56. Blossom DB, McDonald LC. The challenges posed by reemerging Clostridium difficile infection. Clin Infect Dis. 2007; 45:222–7.