Prophylactic treatments for recurrent urinary tract infections

Different prophylaxis protocols against recurrent urinary tract infections (RUTI) are available and have proven to be effective. A prospective, multicentre, observational study demonstrated some noteworthy relationships between the clinical profile and the prophylactic treatment chosen [1].

Prof. María Fernanda Lorenzo Gómez (University of Salamanca, Spain) and colleagues evaluated approximately 1,600 adult women who received prophylaxis against RUTI within 1 year. Each doctor could freely assign any prophylactic treatment following the recommendations of the EAU Guidelines on Urinary Tract Infections in shared decision-making with the patient. The objective was to identify the distribution of clinical profiles associated with several prophylaxis protocols against RUTI.

Based on treatment choices, patients were stratified into 3 study groups:

• Group A (n=444) received conventional antibiotic prophylaxis, namely ciprofloxacin, fosfomycin, cotrimoxazole, nitrofurantoin, or amoxicillin.
• Group B (n=732) received prophylaxis with sublingual polyvalent bacterial vaccine.
• Group C (n=438) received adjuvant measures other than antibiotic or polyvalent bacterial vaccine, namely pelvic floor biofeedback, oral D-mannose, endovesical instillation of glycosaminoglycans, or topical vaginal oestrogen.

Groups were compared concerning age, concomitant disease and treatments, and American Society of Anesthesiologists’ Physical Status Classification System (ASA) scores.

Mean age was significantly different according to age per group; age was lowest in group B (52.27 years), followed by group A (57.25 years) and group C (60.57 years; P=0.00057). Women using antibiotics as a prophylactic treatment for RUTI more frequently had diabetes mellitus, depression, and insomnia.

Concerning the ASA scores, ASA I was more frequent in group B (63.11%) than in group C (48.63%). ASA II was more frequent in group C (39.73%) than in group A (27.03%) and B (30.33%), and ASA III was more frequent in group C (11.64%) than in group B (6.56%) and A (10.14%).

The use of a polybacterial vaccine to prevent RUTI was associated with less arterial hypertension and lower ASA III. In those who received combined treatments, younger women were more prone to choose pelvic floor biofeedback, whereas older women preferred vaginal oestrogens.

1. Lorenzo Gomez MF, et al. Relationship between the clinical profile of women with recurrent urinary tract infections and the prophylactic treatment chosen. P0154, EAU21 Virtual, 8­–12 July 2021.

 

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Posted on 31 August 2021