Pharmacotherapeutic advances for recurrent urinary tract infections in women

ABSTRACT

Introduction

Treatment of recurrent Urinary tract infections (UTIs) has become challenging because of the dramatic increase in the rates of recurrent infection andof multidrug-resistant (MDR) infections.

Areas covered

The authors review recurrent UTIs(rUTI) management in women.

Expert opinion

Continuous or post-coital prophylaxis with low-dose antimicrobials or intermittent self-treatment has all been demonstrated to be effective in managing rUTIs in women. Intravaginal estrogen therapy , shows potential toward preventing rUTI. Oral vaccine Uro-Vaxom seems to reduce the number of UTIs. There is evidence that other therapies (e.g. cranberry, Methenamine hippurate, oral D-mannose) may decrease the number of symptomatic UTIs. The treatment of CRE-UTIs is focused on a colistin backbone. Carbapenems are considered first-line agents for UTIs caused by ESBL, but their use is associated with increased MDR. The usage of non-carbapenem for the treatment of ESBL UTIs is necessary. Cefepime, Piperacillin-Tazobactam, Ceftolozane-Tazobactam, and Ceftazidime-Avibactam are justified options. Oral therapy with Pivmecillinam, Fosfomycin, and Nitrofurantoin can be used against uncomplicated UTIs due to ESBL infection.

KEYWORDS:

• Urinary Tract Infection
• prevention
• CRE bacteria infection treatment
• ESBL treatment
• recurrence
• women

Article highlights

• Recurrent UTI(rUTI) is defined as ≥3 UTI/year or ≥2 UTI/half year.

• Continuous antibiotic prophylaxis is considered when standard simple preventive measures fail to prevent rUTIs. For this purpose, low-dose antibiotics can be given daily for 6 months or longer.

• When rUTI is related to sexual activity, post-coital therapy is considered an effective alternative prophylactic approach.

• There is some evidence that cranberry may decrease the number of symptomatic UTIs over a 12 month in women.

• Intravaginal estrogen therapy, but not oral estrogen, shows a potential to prevent rUTI.

• Oral vaccine (Uro-Vaxom®) significantly decreased the rate of UTI recurrence with a good safety profile.

• Treatment options for UTIs due to ESBLs-producing pathogens in women include carbapenem and intravenous noncarbapenems: Cefepime, Piperacillin-Tazobactam, Ceftazidime-Avibactam, Ceftolozane-Tazobactam. Oral noncarbapenems include Fosfomycin, Nitrofurantoin and Pivmecillinam.

• Treatment options for UTIs caused by carbapenem-resistant Enterobacteriaceae (CRE) are the new anti-CRE antibiotics: Ceftazidime-Avibactam, Meropenem-Vaborbactam, Plazomicin, Imipenem-Relebactam.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.