recurrent UTIs Archives

Antibiotic Stewardship for Procedures and Patients with Recurring Infections

by Brian J. Flynn, MD | Mar 2024

Brian J. Flynn, MD, presents guidance on effective UTI management while minimizing antibiotic resistance. Dr. Flynn begins with an overview of recurring UTI pathogenesis and diagnosis.

Dr. Flynn then addresses common treatment options for recurrent UTI management, like Fosfomycin. He reviews the common first-line antibiotics, highlighting the importance of short-duration antibiotics after non-antibiotic treatments have failed.

Dr. Flynn then delves into other prophylactic strategies for treating recurrent UTIs. He discusses prophylactics relating to cleanliness, specific cranberry products, water intake, and methanamine hippurate.

Dr. Flynn concludes by addressing the social and psychological impact of recurrent UTIs, particularly in post-menopausal women. He stresses the importance of discussing contributing factors frankly, but empathetically, with patients to achieve the desired treatment outcome.

Tips and Tricks for Managing Stones in the Complex Patient

by Colin E. Kleinguetl, MD | Feb 2024

Colin E. Kleinguetl, MD, presents guidance and strategies for kidney stone management in chronically infected and pregnant patients. He begins by discussing challenges to managing kidney stones in the pregnant patient, including:

The weaknesses of kidney stone imaging options
The pros and cons of radiation during diagnosis
The importance of working with the patient’s OBGYN during treatment
The treatment options available to pregnant kidney stone patients

Dr. Kleinguetl concludes by turning to patients with chronic UTIs, acknowledging the circular relationship between recurrent/persistent UTI and kidney stone disease. He then addresses common causes of stones in chronically infected patients and effective treatment options depending on the cause of the infection.

Fear and Frustration Among Women with Recurrent UTIs

by Victoria C. Scott, MD | Jan 2022

In conversation with A. Lenore Ackerman, MD, PhD, Assistant Professor of Urology and Director of Research in the Division of Female Pelvic Medicine and Reconstructive Surgery at the University of California, Los Angeles, Ja-Hong H. Kim, MD, Associate Professor in the Division of Pelvic Medicine and Reconstructive Surgery at the University of California, Los Angeles, and Victoria C. Scott, MD, Associate Program Director of the FPMRS Fellowship at Cedars-Sinai Medical Center, discuss a recent study of the experience of women with recurrent urinary tract infections (rUTIs). Dr. Scott explains that 29 women were recruited to participate in 1 of 6 focus group discussions to investigate the perspective of women suffering from rUTIs. She then lists some preliminary themes from the discussions with the women, including fear of development of antibiotic resistance, widespread knowledge of the collateral damage from antibiotics, concern about taking unnecessary antibiotics, anger at physicians for “throwing” antibiotics at them, a feeling that the medical profession underestimates the impact of rUTIs, a need for research on nonantibiotic options for prevention and treatment, and resentment towards the medical system for not dedicating more research efforts to providing more timely diagnosis. Dr. Scott synthesizes these themes into two emergent concepts: fear about the overuse of antibiotics and frustration at the medical system for not providing alternative treatments or taking rUTI symptoms seriously. Dr. Kim then notes that this initial study has produced two additional studies on the current management of rUTIs that take expert and personal care provider experiences into account. Dr. Ackerman highlights the importance of data capturing that patients are not seeking antibiotics necessarily in the way doctors assume they are, though Dr. Kim does add the caveat that the women in the study were a relatively homogeneous group of college-educated white women. Dr. Ackerman also muses that the attitudes expressed in this study suggest that this population may be interested in a vaccine for rUTIs. Drs. Ackerman, Scott, and Kim conclude by noting that the study made evident the importance to patients with rUTIs of focusing on their experience rather than merely the clearance of bacteria.

Fear and Frustration Among Women with Recurrent UTIs

by Ja-Hong H. Kim, MD | Dec 2021

In conversation with A. Lenore Ackerman, MD, PhD, Assistant Professor of Urology and Director of Research in the Division of Female Pelvic Medicine and Reconstructive Surgery at the University of California, Los Angeles, Ja-Hong H. Kim, MD, Associate Professor in the Division of Pelvic Medicine and Reconstructive Surgery at the University of California, Los Angeles, and Victoria C. Scott, MD, Associate Program Director of the FPMRS Fellowship at Cedars-Sinai Medical Center, discuss a recent study of the experience of women with recurrent urinary tract infections (rUTIs). Dr. Scott explains that 29 women were recruited to participate in 1 of 6 focus group discussions to investigate the perspective of women suffering from rUTIs. She then lists some preliminary themes from the discussions with the women, including fear of development of antibiotic resistance, widespread knowledge of the collateral damage from antibiotics, concern about taking unnecessary antibiotics, anger at physicians for “throwing” antibiotics at them, a feeling that the medical profession underestimates the impact of rUTIs, a need for research on nonantibiotic options for prevention and treatment, and resentment towards the medical system for not dedicating more research efforts to providing more timely diagnosis. Dr. Scott synthesizes these themes into two emergent concepts: fear about the overuse of antibiotics and frustration at the medical system for not providing alternative treatments or taking rUTI symptoms seriously. Dr. Kim then notes that this initial study has produced two additional studies on the current management of rUTIs that take expert and personal care provider experiences into account. Dr. Ackerman highlights the importance of data capturing that patients are not seeking antibiotics necessarily in the way doctors assume they are, though Dr. Kim does add the caveat that the women in the study were a relatively homogeneous group of college-educated white women. Dr. Ackerman also muses that the attitudes expressed in this study suggest that this population may be interested in a vaccine for rUTIs. Drs. Ackerman, Scott, and Kim conclude by noting that the study made evident the importance to patients with rUTIs of focusing on their experience rather than merely the clearance of bacteria.

Fear and Frustration Among Women with Recurrent UTIs

by A. Lenore Ackerman, MD, PhD | Nov 2021

In conversation with A. Lenore Ackerman, MD, PhD, Assistant Professor of Urology and Director of Research in the Division of Female Pelvic Medicine and Reconstructive Surgery at the University of California, Los Angeles, Ja-Hong H. Kim, MD, Associate Professor in the Division of Pelvic Medicine and Reconstructive Surgery at the University of California, Los Angeles, and Victoria C. Scott, MD, Associate Program Director of the FPMRS Fellowship at Cedars-Sinai Medical Center, discuss a recent study of the experience of women with recurrent urinary tract infections (rUTIs). Dr. Scott explains that 29 women were recruited to participate in 1 of 6 focus group discussions to investigate the perspective of women suffering from rUTIs. She then lists some preliminary themes from the discussions with the women, including fear of development of antibiotic resistance, widespread knowledge of the collateral damage from antibiotics, concern about taking unnecessary antibiotics, anger at physicians for “throwing” antibiotics at them, a feeling that the medical profession underestimates the impact of rUTIs, a need for research on nonantibiotic options for prevention and treatment, and resentment towards the medical system for not dedicating more research efforts to providing more timely diagnosis. Dr. Scott synthesizes these themes into two emergent concepts: fear about the overuse of antibiotics and frustration at the medical system for not providing alternative treatments or taking rUTI symptoms seriously. Dr. Kim then notes that this initial study has produced two additional studies on the current management of rUTIs that take expert and personal care provider experiences into account. Dr. Ackerman highlights the importance of data capturing that patients are not seeking antibiotics necessarily in the way doctors assume they are, though Dr. Kim does add the caveat that the women in the study were a relatively homogeneous group of college-educated white women. Dr. Ackerman also muses that the attitudes expressed in this study suggest that this population may be interested in a vaccine for rUTIs. Drs. Ackerman, Scott, and Kim conclude by noting that the study made evident the importance to patients with rUTIs of focusing on their experience rather than merely the clearance of bacteria.

Beyond Antibiotics: Introducing Vaccine-Based Approaches to Recurrent UTIs in Women

by J. Curtis Nickel, MD, FRCSC | Mar 2021

J. Curtis Nickel, MD, FRCSC, the Canada Research Chair in Urologic Pain and Inflammation and Professor of Urology at Queen’s University in Kingston, Ontario, gives an overview of current and prospective treatment for recurrent urinary tract infections (UTIs), focusing on alternatives to antibiotics. He begins by summarizing the history of antibiotics for UTIs, noting that new antibiotics were discovered very quickly from the 1940s through the 1970s and that doctors believed at the time that infectious diseases would soon be a problem of the past. However, antibiotic-resistant microbes are now so prevalent that Dr. Nickel suggests that humanity is entering the “post-antibiotic era.” He then considers the available non-antibiotic treatments for recurrent UTI prevention in pre- and postmenopausal women. For premenopausal women, traditionally-recommended alternative prophylactic treatments include changes in hygiene practices, pre- and post-coital voiding, and avoidance of hot tubs, tampon use, and douching, but guidelines say that case-control studies demonstrate that these suggestions do not significantly impact recurrent UTI risk and can reinforce shame and self-blame. Dr. Nickel lists several alternative therapies with varying levels of evidence for this cohort, including increased water intake, cranberry extract, probiotics such as D-mannose, and methenamine hippurate. Dr. Nickel also recommends probiotics, D-mannose, and cranberry for postmenopausal women, though he also notes that the evidence-based approach for this cohort is vaginal estrogen therapy. According to Dr. Nickel, the future of recurrent UTI prevention for both cohorts is a vaccine. In the final part of his presentation, Dr. Nickel looks at treatment options for symptomatic UTI. Guidelines suggest antibiotics in these cases, but evidence indicates that UTI is typically self-limited and rarely progresses to more severe disease, and that there is little benefit to antibiotics for UTI beyond modestly faster symptomatic improvement. Dr. Nickel suggests treating symptomatic UTI with phenazopyridine, NSAIDS, urine alkalization, methenamine hippurate, and even herbal and dietary therapies. After summarizing his key points, Dr. Klotz goes into greater depth regarding vaccines for UTI prevention in a conversation with E. David Crawford, MD.