Recurrent UTI

Question 1

Relapse - attributes - 3

Answer 1

• Same pathogen
• Usual within 1/2 w after Tx. completion
• Usually related to renal inf. struc. abn. or chronic bacterial prostasis

Question 2

Reinfection - attributes - 2

Answer 2

• Can be a different pathogen

- Usually after more then 2 w. after Tx. completion.

Question 3

Relapse - Tx. - 7

Answer 3

• Obtain urine culture
• Do imaging studies
• Remove foreign bodies when possible
• Correct obstruction
• Drain foci of infection
• If previously treated for cystitis consider treatment course for upper UTI
• If all fails and relapses are frequent- consider prolonged course of antibiotics (>4w) and maybe even long term suppressive therapy

Question 4

Reinfection - Tx. - 5

Answer 4

-Self administered standard short course therapy with onset of symptoms
-When related to sexual activity-
• Urination after intercourse
• Single dose prophylactic Tx after intercourse
-For postmenopausal women consider oral or intravaginal estrogens
-Intravaginal probiotics - to change vaginal flora
-For very frequent reinfections without percipitating event- consider long term antibiotic prophylaxis - Macrodentin or Resprim or
- A lot of cranberry juice + urine pH↓ Urinary hippuric acid↑

another theory: fructose and proanthocyanidine (from cranberry juice) coat E. coli fimbriae E. Coli cannot adhere to uroepithel – not proven