Urinary Tract Infections in Women
Over the years, I have helped scores of women with frequent, recurring urinary tract infections (UTIs). Since many recommendations have changed over the last decade, I decided to answer the question right away. Because some common practices have turned out to be unhelpful, an update is timely and warranted.
First, involvement of your primary care provider is critical. “Must not miss” disorders need to be considered prior to going forward with the recommendations given below.
Second, how do you define recurrent urinary tract infection? Most define recurrent UTI as when a woman has two or more symptomatic urinary tract infections in six months or three or more symptomatic UTIs over 12 months. What makes this definition less precise is the fact that the degree of discomfort in the woman usually is the determining factor that leads her to present to her primary care provider. Frustration usually motivates the woman to act.
Once your primary provider has determined you have recurring UTI’s, the following recommendations may be made for young, healthy, non-pregnant women:
For sexually active women:
- If spermicides or diphragms are used, an alternative form of contraception may be recommended.
- Drinking fluid and urinating after sexual intercourse: studies have not proven the effectiveness of this strategy. Although some providers opine that this “doesn’t hurt,” my opinion is that if it doesn’t help, why do it?
- Antibiotics are highly effective. There are many ways to effectively use antibiotics to prevent recurrent urinary tract infections (see below).
- Cranberry juice and concentrated cranberry extract tablets have not been proven to be effective. In my opinion, the cost, the calories, and the unpalatable taste make other alternatives desirable.
- Low dose antibiotics daily
- Low dose antibiotics three times a week
- Antibiotics after sexual intercourse
- Alternatively, at the first sign of a urinary tract infection, when you first notice symptoms, an antibiotic is taken.
Studies have suggested these methods are efficacious for six months up to several years of therapy.
- Does the type of antibiotic prescribed make a difference? It turns out that all antibiotics are equally effective. Some antibiotics have to be dosed for kidney disease. Antibiotics can have side effects including diarrhea and yeast infections. That’s why your primary provider is there to give you advice.
- Do I have to worry about drug resistance? Yes, however it turns out that drug resistance is rare in this setting. Sometimes a urine culture is needed to see if the antibiotics are treating the organism causing the infection.
So that is the latest information on the treatment of recurrent urinary tract infections. If you have a follow up question or comment, please feel free to ask.
These blogs are written by members of the CHI Health Nephrology team.
If studies have not proven the effectiveness of urinating before intercourse and taking cranberry supplements, my question would be "have the appropriate studies been done to DISprove these methods?" I think you Dr. Aaronson is too quick to dismiss these options. In my opinion, it is always better to prevent than treat a disease. I'm not saying preventative methods are necessarily effective, but they are definetely worth looking into as a cheaper (when you add in doctor visits), more natural, safer alternative to taking antibiotics, which can have unwanted side effects. And I can speak from experience when I say that even minor inconveniences like taking cranberry pills and urinating after intercourse are much preferable than the pain of an infection.
Michael Aaronson, MD
Some people swear by cranberry extract. The concern I have with non-prescription, over the counter products is that the amounts of active ingredients are not regulated. So you cannot know for sure you are taking what you think you are taking. Other countries actually regulate nutraceuticals. Another common misconception is that supplements are harmless. Did you know that there is an interaction between warfarin and cranberry juice? http://www.medscape.com/viewarticle/545631 Therefore, to prevent problems I would recommend having a primary physician to help individualize a plan of care which can include the use of cranberry juice to prevent uti. Consider reading my blog: "Getting Value from Your Medical Appointments" to maximize your visit with your provider. Finally, although cranberry juice has not been proven in a randomized controlled trial that doesn't mean it is not effective. I'm glad you found a solution that works for you!