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    peter bondad

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    UTI THREAD

    Post  peter bondad on Wed 12 Aug 2009, 11:37 pm

    CLASS,

    1. WHAT IS THE SIGNIFICANT DIFFERENCE BETWEEN A SHORT-TERM AND THE USUAL 7-14DAY ANTIBIOTIC TREATMENT?
    2. WHAT PROGRAM/INTERVENTION PREVENTS RECURRENT UTI?

    PROF. BONDAD

    NOTE: ALL RESPONSES TO THE THREAD SHOULD BE SUPPORTED BY LITERATURES.

    DEADLINE FOR ALL THREAD RESPONSES IS ON MONDAY AUG 17 11PM.
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    gil_legarda

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    GIL LEGARDA - Answer

    Post  gil_legarda on Sat 15 Aug 2009, 12:39 pm

    By: GIL LEGARDA



    ANSWER NO 1: Based on the evidences showed in many studies in this meta analysis a short term course therapy of azithromycin, erythromycin or clarithromycin is as effective as a long term 2 weeks treatment in eradicating Bordetella pertusis in the nasophraynx.



    TITLE: What is the best treatment for pertussis?
    BY: Charles Tubbs, Heli Niemi, Helen G. Mayo

    A meta-analysis study to identify the difference in efficacy and effectiveness between short term and long term antibiotic therapy for pertusis. Cochrane review of 11 Randomized controlled Trials and 1 quasi-randomized trial, with a total of 1720 adults and children, investigated several antibiotics for treatment and prophylaxis of pertussis. The outcome measures used to assess the efficacy of antibiotic treatment or prophylaxis vary between the trials. This study is heald in the American Academy of Pediatrics.

    A short-term course of erythromycin, azithromycin, or clarithromycin is as effective as a long-term or 2 weeks erythromycin therapy in eradicating Bordetella pertussis from the nasopharynx based on one meta-analysis of randomized controlled trials. Evidence is insufficient to determine the benefit of antibiotic prophylaxis for pertussis contacts. However, due to high mortality and morbidity, prophylaxis is recommended for families who have an infant less than 6 months old which is based on an expert opinion.

    The effectiveness of an antibiotic therapy can only be measured by the strict compliance to medications. The issue regarding this is the cost or the expenses for the antibiotic will be a burden most especially for the depressed community that compliance for medication is not their concern but the alternatives suggested are easy to use and are as equally effective as the first-line therapy of erythromycin estolate, the long-term treatment recommended by the CDC and the AAP. These alternatives, clarithromycin and azithromycin, require either twice a day or a once a day dosing for 7 days or 3 days respectively, can be accommodated in busy households, thus promoting better compliance.


    Reference:
    Tubbs C. et al. (2005). What is the best treatment for pertusis? Journal of Family Practice. Vol. 54, No. 12 pages 1096-1098
    http://www.jfponline.com/Pages.asp?AID=3704









    ANSWER NO 2: Based on this 2 years pilot study a cranberry preparation with a high phenolic content may completely prevent urinary tract infections in women.

    TITLE: Can a concentrated cranberry extract prevent recurrent urinary tract infections in women? A pilot study
    By: David T. Bailey, Carol Dalton, F. Joseph Daugherty, Michael S. Tempesta

    This is a pilot study by Bailey D.T. et al to examine the ability of a concentrated cranberry preparation to prevent UTIs in women with a history of recurrent infections. Urinary tract infections are extremely prevalent and despite treatment with antibiotics, reoccurences is common causing frustration in the patient and the potential for developing antibiotic resistance. The subjects enrolled in this study include women between ages 25 to 70 with a history of minimum of 6 urinary tract infections in the preceding year. As an intervention they were asked to take once capsule twice daily for twelve weeks containing 200 mg of concentrated Cranberry extract standardized to 30 percent phenolics. A questionnaire was used initially to determine the patient’s medical history and they were asked at monthly intervals if any of the information had changed. All the subjects enrolled had a urinalysis within 24 hours before starting on the study preparation.

    The result of this pilot study shows that all 12 subjects participated in the twelve weeks study and were available for follow up to 2 years later. During the study none of them had urinary tract infection. No occurrence or reported side effects among all the subjects enrolled. After a 2 years of continue taking cranberry, continue to be free from urinary tract infection. Also this research concluded that a cranberry preparation with a high phenolic content may completely prevent urinary tract infections in women who subject to have recurrent infections.

    This type of program or intervention will be beneficial for the women because they are high risk in having this infection. Kidney infection may lead to renal failure and this will be a serious complication of this infection.

    Reference:
    Bailey T.D. et al. (2007). Can a concentrated cranberry extract prevent recurrent urinary tract infections in women? A pilot study. Phytomedicine, Volume 14, Issue 4, Pages 237-241
    http://linkinghub.elsevier.com/retrieve/pii/S0944711307000086


    Last edited by gil_legarda on Sun 16 Aug 2009, 10:56 pm; edited 1 time in total
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    joanalyn_balino

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    Response-Joanalyn S. Balino

    Post  joanalyn_balino on Sun 16 Aug 2009, 3:40 pm

    Question 1

    1.WHAT IS THE SIGNIFICANT DIFFERENCE BETWEEN A SHORT-TERM AND THE USUAL 7-14DAY ANTIBIOTIC TREATMENT?

    Answer: There is no significant difference between a short-term and the usual 7-14 day antibiotic treatment. Short- term antibiotic treatment appears to be as effective as 7-14 days in treating UTI. This is supported by the study made by Vogel, T. et al(2004).

    Optimal duration of antibiotic therapy
    for uncomplicated urinary tract infection in older
    women: a double-blind randomized controlled trial

    Thomas Vogel, René Verreault, Marie Gourdeau, Michèle Morin, Lise Grenier-Gosselin,Louis Rochette


    Vogel, T. et al. made a study which is randomized controlled double-blind noninferiority trial that aims to compare Short term (3-day) and the standard 7-day courses of oral antibiotic therapy using ciprofloxacin in managing uncomplicated symptomatic UTI in older women. Inclusion Criteria: Women with age ranging from 65 years and above; Has uncomplicated symptomatic UTI (lower UTI or Cystisis) that has significant bacterinuria with 1 to 6 possible symptoms like dysuria, frewuency, suprapubic, pain urgency, burning on micturition and other symptoms. Exclusion criteria: Those with signs of pyelonephritis or septic shock; creatinine clearance less than 30ml min–1 1.73 m–2.; use of antibiotics in the preceding 3 days; Have hypersensitivity to fluoroquinolones; structural or functional abnormalities of the urinary tract; residual volume greater than 100 mL; use of an indwelling catheter in the previous six days; in the state of immune deficiency; and with Diabetes mellitus. 183 Participants were randomly assigned to 1 of 2 treatment groups. 93 participants were assigned to treatment 1 (ciprofloxacin 250 mg given orally twice daily for 3 days followed by placebo twice daily for 4 days (the 3-day group). And 90 were assigned to treatment 2 which is given ciprofloxacin 250 mg given orally twice daily for 7 days (the 7-daygroup).


    There was no significant difference in rates of bacterial eradication 2 days after the completion of treatment between the Short-term (3-day group) and the 7-day groups(p = 0.16). There were also no significant differences in the rates of reinfection or relapse at 6 weeks after completion of treatment. Improvement in symptoms at 2 days after completion of antibiotic therapy was outstanding in both groups ( 98%of subjects in the 3-day group and 92% in the 7-day group reported disappearance or improvement in at least1 symptom p=0.15. Improvements in specific symptoms were similar for both groups except for the symptom of urgency. The 7 day group had better clinical improvement in the symptom of urgency compare to the 3-day group p=0.05. Adverse events such as drowsiness, loss of appetite, and nausea or vomiting were relatively frequent in both groups during the initial 9-day study period. The mean number of reported adverse events per subject was less for the 3-day group than for the 7-day group p < 0.001.

    The results of this randomized controlled double-blind clinical trial made by Vogel, T. Verreault, R. et al. recommend that a 3-day course of an antibiotic with proven efficacy is not inferior to a 7-day course for the treatment of uncomplicated symptomatic UTI in older women. The adverse events are less frequent with the shorter course (3-day) of therapy. Shorter antibiotic treatment (3-day) may also contribute to better compliance and fewer drug interactions and may thus be of particular interest for the older population.

    Vogel, T. Verreault, R. et al.(2004). Optimal duration of antibiotic therapy for uncomplicated urinary tract infection in older women: a double-blind randomized controlled trial. CMAJ;170(4):469-73. Retrieved August 13, 2009 from. http://www.cmaj.ca/cgi/reprint/170/4/469


    Question 2

    WHAT PROGRAM/INTERVENTION PREVENTS RECURRENT UTI?

    Answer: Interventions to prevent recurrent UTI were prophylactic antibiotics and complementary interventions like probiotics, cranberry, and horseradish.

    Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women

    Tero Kontiokari, Kaj Sundqvist, M Nuutinen, T Pokka, M Koskela, M Uhari

    Kontiokari, T.et al. conducted an open, randomised, controlled trial to assess whether cranberry-lingonberry juice and Lactobacillus GG drink given orally are effective in preventing symptomatic recurrences of urinary tract infection. A total of 150 women participated in the study and were randomly allocated into three groups. The first group (50 participants) received 50 ml of cranberry-lingonberry juice concentrate a day for six months. The second group(50 participants) received 100 ml of Lactobacillus GG drink five days a week for one year. The third group comprised of 50 participants served as an open control group. Participants were women who had a urinary tract infection caused by Escherichia coli and not taking antimicrobial prophylaxis.

    During the six months, 8 women in the cranberry group, 19 in the lactobacillus group, and 18 in the control group had at least one episode of urinary tract infection 16%, 39%, and 36% respectively. There is 20% reduction in absolute risk in the cranberry group compared with the control group. The numbers who had a recurrence at 12 months were 12 in cranberry group , 21 in the lactobacillus group, and 19 in the control groups. Recurrence during the study period at 6 months P=0.014 and at 12 months P=0.052 was significantly lower in the cranberry group than in the control group. During follow up, a total of 98 episodes of urinary tract infection occurred: 21 (21%) occurred in the cranberry group; 39 (40%) in the lactobacillus group; and 38 (39%) in the control group.

    The results of this open, randomised, controlled trial made by Kontiokari, T.et al. suggest that the daily consumption of 50 ml of cranberry-lingonberry concentrate prevented recurrences by about half of symptomatic urinary tract infection in women, whereas the lactobacillus drink was somehow ineffective. Cranberry-lingonberry concentrate is a natural food product and readily available which means it is a useful way for self administered prevention of urinary tract infection.

    Kontiokari, T, Sundqvist, K.et al.(2001). Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women. BMJ 322:1571. Retrieved August 13, 2009 from http://www.bmj.com/cgi/content/full/322/7302/1571?view=long&pmid=11431298#SEC4
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    alkhaloidz

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    ANSWER-BOND BALAJADIA

    Post  alkhaloidz on Sun 16 Aug 2009, 9:39 pm

    # 1 ANSWER: I agree to Ms. Balino's answer that there is no significant difference between the short-term antibiotic therapy compared to the standard 7-14 days of antibiotic therapy. A 2-4 day course of oral antibiotics appears to be as effective as 7-14 days in eradicating lower tract UTI. Our answer is further supported by the study below:

    Short versus standard duration oral antibiotic therapy for acute urinary tract infection in children

    The optimal duration of oral antibiotic therapy for urinary tract infection (UTI) in children has not been determined. A number of studies have compared single dose therapy to standard therapy for UTI, with mixed results. A course of antibiotics longer than a single dose but shorter than the usual 7-10 days might decrease the relapse rate and still provide some of the benefits of a shortened course of antibiotics. The objective of this review was to assess the benefits and harms of short-course (2-4 days) compared to standard duration (7-14 days) oral antibiotic treatment for acute UTI in children. Randomised and quasi-randomised controlled trials comparing short-term (2-4 days) with standard (7-14 days) oral antibiotic therapy were selected if they studied children aged three months to 18 years with culture proven UTI. Two reviewers independently assessed trial quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) with 95% confidence intervals (95% CI). Ten trials were identified in which 652 children with lower tract UTI were evaluated. There was no significant difference in the frequency of positive urine cultures between the short (2-4 days) and standard duration oral antibiotic therapy (7-14 days) for UTI in children at 0-10 days after treatment (eight studies: RR 1.06; 95% CI 0.64 to 1.76) and at one to 15 months after treatment (10 studies: RR 0.95; 95% CI 0.70 to 1.29). There was no significant difference between short and standard duration therapy in the development of resistant organisms in UTI at the end of treatment (one study: RR 0.57, 95% CI 0.32 to 1.01) or in recurrent UTI (three studies: RR 0.39, 95% CI 0.12 to 1.29).

    Reference: Michael, M. et al. Short versus standard duration oral antibiotic therapy for acute urinary tract infection in children. PMC. 2003

    # 2 ANSWER: I found an interesting research about treating and preventing recurrent complicated and uncomplicated urinary tract infection (UTI). According to the research below, the author considered the use of PROBIOTICS (live microorganism) as an alternative to manage UTI. This is due to the fact that using antibiotic therapy as treatment became ineefective and costly due to the proliferation of multi-resistant microorganism.

    Prevention and treatment of urinary tract infection with probiotics: Review and research perspective

    The spiralling costs of antibiotic therapy, the appearance of multiresistant bacteria and more importantly for patients and clinicians, unsatisfactory therapeutic options in recurrent urinary tract infection (RUTI) calls for alternative and advanced medical solutions. So far no sufficient means to successfully prevent painful and disabling RUTI has been found. Even though long-term oral antibiotic treatment has been used with some success as a therapeutic option, this is no longer secure due to the development of bacterial resistance. One promising alternative is the use of live microorganisms (probiotics) to prevent and treat recurrent complicated and uncomplicated urinary tract infection (UTI).
    The human normal bacterial flora is increasingly recognised as an important defence to infection. Since the advent of antibiotic treatment five decades ago, a linear relation between antibiotic use and reduction in pathogenic bacteria has become established as medical conventional wisdom. But with the use of antibiotics the beneficial bacterial flora hosted by the human body is destroyed and pathogenic bacteria are selectively enabled to overgrow internal and external surfaces. The benign bacterial flora is crucial for body function and oervgrowth with pathogenic microorganisms leads to illness. Thus the concept of supporting the human body's normal flora with live microorganisms conferring a beneficial health effect is an important medical strategy.

    General Remarks on Probiotics

    Epidemiological evidence is an important reason to support research on alternative treatment options. There is a epidemiological evidence on significant problems with multiresistant bacteria (bacteria resistant to multiple antibiotics) like Clostridium difficile (C. difficile) and methicillin resistant Staphylococcus aureus (MRSA) in the UK and elsewhere. The development of bacterial resistance relies on several factors. One of these is the widespread use of antibiotics. Frequent use of quinolones in urology departments may contribute to the outbreaks in antibiotic associated C. difficile diarrhoea. Alternative therapeutic options should use strategies to (a) prevent the selective development of antibiotic resistant bacterial strains, (b) restore a balanced microbial flora and (c) enhance the defence mechanisms of the human body. These criteria are best fulfilled by live microorganisms which are naturally hosted by the human body already. Positive and convincing effects have already been shown, e.g., in reducing complications after major abdominal surgery and acute and chronic diarrhoea. A recent report on the use of probiotics in antibiotic-associated diarrhoea underlines that this is possible already with commercially available probiotic drinks. So far, no sufficient trials have been undertaken to support the use of probiotics in patients with RUTI.

    Trials on Efficacy

    Trials with probiotics in diseases other than RUTI
    Investigation and trials with probiotics have so far covered a wide range of diseases and included the prevention and treatment of caries and tonsillitis; gastrointestinal disease like acute and chronic diarrhoea, irritable bowel syndrome and Helicobacter pylori infection, as well as in the immunocompromised host with drug-associated diarrhoea. Randomised-controlled trials and prospective investigations have been performed in critically ill patients with acute pancreatitis and in major abdominal surgery. To date there is supporting but not sufficient data to generally recommend the use of probiotics in critically ill patients and those undergoing major surgery, although results of recent randomised trials have been very encouraging. For different types of diarrhoea, sufficient data are now available resulting in repeated meta-analysis. This allows the targeted clinical use of probiotics in antibiotic-associated and travellers diarrhoea. Antibiotic-associated C. difficile positive diarrhoea is a problem to all medical specialities and so it is for urology. Therefore, off definitive interest for urologists is the finding that not only clinical preparations of specific probiotics, but also commercially available probiotic preparations like probiotic drinks are effective in preventing and treating this type of diarrhoea. From these trials, definitive recommendations can be given for the use of probiotics in acute and chronic diarrhoea. Again of significant interest for the urologist within the multidisciplinary care and treatment of prostate cancer patients is the finding that probiotics are effective in preventing radiation-induced diarrhoea.

    Trials with probiotics
    Trials on the use of probiotics in urology patients to date had small numbers of participants only. There are small studies on the use of probiotics in renal calculi due to enteric hyperoxaluria, recurrent candida vulvovaginitis, as well as UTIs. In patients with neurogenic bladder trials with encouraging results have been performed with instillation of non-pathogenic E. coli into the bladder. To date two clinical trials are on the way to explore the effects of oral and topical probiotics in RUTI. No trials in this area have been started or performed in the UK.
    The RUTI is a significant healthcare problem worldwide for many women and even more so in specific patient populations. Patients with spinal cord injury and neurogenic bladder as well as patients with long-term urinary catheter all share the problem of RUTI. These patients do have more complicated UTI and develop resistance to standard antibiotics. The recent reports on MRSA, C. difficile and other problem pathogens in the UK leave no doubt that alternative, preventive and economic therapeutic options to antibiotics are urgently needed.
    The use of oral probiotics has not been sufficiently tested in RUTI and they have not been tested at all in patients with neurogenic bladder or long-term urinary catheter. Recently, Darouiche et al. tested the topical use of probiotics in patients with neurogenic bladder. After instillation of a benign E. coli strain into the bladder of these patients, they found decreased rates of RUTI especially in those, where the bladder was successfully colonised. The same group started to look at urinary catheters coated with probiotic microorganisms in contrast to catheters coated with antimicrobials. Twelve adult inpatients with neurogenic bladders requiring indwelling urinary catheters had E. coli HU2117-coated catheters inserted for 28 days. With this method, the rate of symptomatic UTI was reduced to 0.15 cases per 100 patient-days compared to published average rates of 2.72 cases per 100 patient-days in such patients.[30] In women, the topical use of Lactobacilli released from a vaginal suppository has been investigated in a pilot trial in nine women. It was shown that E. coli positive cultures reduced from 5.0 ± 1.6 episodes to 1.3 ± 1.2, P < 0.0007 over 12-month period.[58] The cited studies did not report any serious side effects or intolerance, but suggested that severely immunocompromised hosts may only be trialled with caution.
    A trial with oral probiotics is currently under way in the Netherlands (NAPRUTI trial) using different strains of oral probiotics, containing L. rhamnosus and Lactobacillus reuteri.[55] In this multicentre double blind trial, 280 postmenopausal women are randomised to receive either oral Lactobacilli or standard antibiotic treatment for RUTI. Patients are treated for 12 months with a follow-up of 3 months. Another trial in the United States investigates the use of a topical single strain probiotic with Lactobacillus crispatus. This single centre trial investigates uncomplicated RUTI in premenopausal women only. A total of 100 female patients are randomised to receive either placebo or topical Lactobacilli as a vaginal capsule for 3 months with a follow-up of 6 months. Neither trial compares premenopausal to postmenopausal treatment with probiotics. Moreover, probiotics are not expected to completely eradicate infections but to lower the rate of recurrence and prevent development of bacterial resistance. In this regard, the trial designs do not describe precautions or scenarios on the use of probiotics in episodes of UTI severe enough to require additional treatment.
    Probiotics can be regarded as the single most powerful alternative option under clinical development for the prevention and treatment of chronic infection. Given the enormous burden on patients, as well as the scientific and economic problem caused by RUTI, the investigation of probiotics is of potentially crucial importance for patient benefit and clinical science. Laboratory and clinical research on live microorganisms have opened a major research field with increasing numbers of investigations and trials. Little is known about the complex interaction of the human bacterial flora with the human body. From an evolutionary point of view, live microorganisms have provided the human body with crucial functions in digestion and immunemodulation. The human body did not have to develop these functions and is employing the hosted flora of microorganisms “as a metabolic ‘organ’ exquisitely tuned to our physiology” on its outer surfaces. The bacterial flora of the gut has a weight of approximately 1-2 kg and is thought to be metabolically as important as the liver. As the live microorganisms used in probiotics are often isolated from the human flora, trials with specific probiotics will help to elucidate the role of these bacteria in the human body's eco-system. Data and experience gained from clinical trials with probiotics will direct laboratory research and help to train clinicians in their future clinical use.
    The harmful effects of antibiotics have always been somewhat overlooked. The scientific importance of trials with probiotics is not only to investigate their potential use in recurrent infection, but also the containment and therapy of the side effects of antimicrobial chemotherapy itself.
    A major concept in urological therapy is to prevent the recurrence of UTI. Investigations on live microorganisms derived from the human gut flora will drive forward the field of preventive medicine in the therapy of RUTI. Similar to nutritional aspects in medicine probiotics acknowledge the complex nature of infection. Despite longstanding knowledge of immunosuppressive effects of poor nutrition, the introduction of perioperative enteral nutrition has only recently been developed. Perioperative enteral nutrition has a major impact on the body's ability to resist infection. This view and treatment strategy has now been added to antibiotic therapy for infection in most surgical specialties, giving evidence of the need for complementary anti-infective prevention and treatment. As described above, despite definitive clinical evidence on the positive effects of probiotics, so far sufficiently powered studies using probiotics in RUTI have only recently been commenced.

    To date insufficient data exists to support the routine use of probiotics in urological diseases such as RUTI or bladder cancer. But probiotics show promise in becoming an alternative or complementary treatment option for many diseases. As probiotics are already in use in many fermented products, there are no major safety concerns. Thus it is probably only the targeted use of these microorganisms which has to be learnt from clinical trials. Probiotics are derived mainly from the human gut flora and belong to a still poorly understood metabolic organ of the human body. Trials on probiotics would help to understand this metabolic organ and use it to counterbalance traditional antimicrobial chemotherapy. Probiotics have the potential for a future alternative prevention and treatment strategy in RUTI. They are also potentially preventive for cancer development and progression. In conclusion, research on the field of live microorganisms advances scientific knowledge on (a) the clinically significant problem of RUTI, (b) on the prevention and treatment of infection in general, (c) on the understanding of the function of the bacterial eco-system within the human body and (d) on the collateral effects of antimicrobial chemotherapy.

    Reference: Borchert, D. et. al. Prevention and treatment of urinary tract infection with probiotics: Review and research perspective. Indian J Urol. 2008 Apr–Jun; 24(2): 139–144. June 2008
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    byron webb romero

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    RESPONSE TO GN THREAD

    Post  byron webb romero on Mon 17 Aug 2009, 2:29 pm

    Difference between the Short-term and Usual Standard) Antibiotic Therapy

    In a comparative study of two meta-analyses by Keren and Chan (2003), there is no significant difference between short (2-4 days) and standard (7-14) days antibiotic therapy of patients with Urinary Tract Infection. This is also supported by the study conducted by Michael, Hodson, Craig, Martin and Moyer (2002) which revealed that there were no significant differences in the frequency of bacteriuria at 0–7 days after completing treatment (eight data sets; RR 1.06, 95% CI 0.64 to 1.76) or in the number of UTIs during 10 days to 15 months follow up (12 data sets; RR 1.01, 95% CI 0.77 to 1.33) between short and standard duration therapy.

    References:

    Keren, R. & Chan, E. (2003). Short versus standard duration antibiotic treatment for UTIs: A comparison of two meta-analyses. Archives of Disease in Childhood 2003; 88:89-91. Retrieved August 17, 2009, from http://adc.bmj.com/cgi/content/full/88/1/89-a.

    Michael, M., Hodson, E.M., Craig, J.C., Martin,S., Moyer, V.A. (2002). Short compared with standard duration of antibiotic treatment for urinary tract infection: a systematic review of randomized controlled trials. Archives of Disease in Childhood 2002; 87; 118-123. Retrieved August 17, 2009, from http://adc.bmj.com/cgi/reprint/87/2/118?ijkey=35bd4d67186ebfd49bef69e27f7ce06f310e315f.


    What Program/ Intervention Prevents Recurrent UTI?


    Approximately 25% of young women who have UTI will have a recurrence within 6 months. Urine cultures should be performed when women have recurrent symptoms within 6 months to confirm the presence of UTI and to test for sensitivities to antibiotics. Cranberry juice or tablets containing proanthocyanidin can reduce the rate of recurrences of UTI by one half, exercising their effect by inhibiting adherence of E coli. Proanthocyanidin is not an effective treatment of UTI once established, however. In postmenopausal women, vaginal estrogens reduce the number of recurrent UTIs by decreasing the vaginal pH and permitting a vaginal flora in which uropathogens are less likely to dominate. There is no evidence of effectiveness for preventive measures, including voiding after sexual intercourse, lactobacillus drinks, and direction of perineal wiping, although this advice is commonly given. Women who have three or more recurrences annually may be offered the option of self-treatment of recurrences. Postcoital use of antibiotic prophylaxis is effective for women who have recurrences with a temporal relationship to intercourse. Continuous antibiotic prophylaxis in a single bedtime dose is also accepted practice for women who have frequent recurrences. Antibiotics that have been shown to reduce the number of recurrences to 0.3 or fewer per year are TMP-SMZ (Trimethoprim-sulfamethoxazole) 40 mg/200 mg, TMP (Trimethoprim)100 mg, norfloxacin 200 mg, and nitrofurantoin macrocrystals 50 to 100 mg.

    Reference:
    French, L., Phelps, K., Pothula, N.R., & Mushkbar, S. (2009). Urinary Problems in Women. Primary Care: Clinics in Office Practice 36 (2009) 53-71.

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    guomanman

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    by guomanman

    Post  guomanman on Mon 17 Aug 2009, 3:41 pm

    A 2–4 day course of oral antibiotics is as effective as 7–14 days in eradicating lower tract UTI in children.

    To compare the effectiveness of short course (2–4 days) with standard duration oral antibiotic treatment (7–14 days) for urinary tract infection (UTI).
    Methods: Meta-analysis of randomised controlled trials using a random effects model. Ten trials were eligible, involving 652 children with lower tract UTI recruited from outpatient or emergency departments. Main outcome measures were UTI at the end of treatment, UTI during follow up (recurrent UTI), and urinary pathogens resistant to the treating antibiotic.
    Results: There was no significant difference in the frequency of positive urine cultures between the short (2–4 days) and standard duration therapy (7–14 days) for UTI in children at 0–7 days after treatment (eight studies: RR 1.06; 95% CI 0.64 to 1.76) and at 10 days to 15 months after treatment (10 studies: RR 1.01; 95% CI 0.77 to 1.33). There was no significant difference between short and standard duration therapy in the development of resistant organisms in UTI at the end of treatment (one study: RR 0.57, 95% CI 0.32 to 1.01) or in recurrent UTI (three studies: RR 0.39, 95% CI 0.12 to 1.29).


    Evidence is insufficient to recommend for or against antibiotic prophylaxis to prevent recurrent urinary tract infections (UTI) in children with anatomic abnormalities. Guidelines acknowledge this lack of evidence, but still recommend using prophylactic antibiotics in children with vesiculoureteral reflux (strength of recommendation: B, based on poor-quality or inconclusive cohort and randomized controlled studies).1-3 No controlled, prospective studies have examined the effectiveness of prophylactic antibiotics to prevent UTI recurrence or renal scarring.

    Recommendations about antibiotic prophylaxis are based on several premises. Reflux predisposes children to acute pyelonephritis; reflux plus infection leads to reflux nephropathy and ultimately to renal scarring. In theory, if antibiotics could be initiated at the appropriate time and be maintained until reflux resolves, we could successfully prevent infection and scarring.4

    A recent systematic review evaluated the use of antibiotics to prevent UTI in children.5 This review of 5 randomized controlled trials included a total of 463 children between the ages of 2 months to 16 years. Three out of 5 trials evaluated the effectiveness of antibiotic treatment for 2 to 6 months to prevent subsequent off-treatment recurrence. The 2 smaller trials (n=71) evaluated the use of low-dose long-term antibiotics to prevent UTI.

    There was a clinically, but not statistically, significant trend towards reduced risk of UTI during long-term antibiotic treatment (risk reduction [RR]=0.31; 95% confidence interval [CI]=0.10–1.00); however, no sustained benefit was seen once antibiotics were stopped (RR=0.79; 95% CI, 0.61–1.02). There were many problems with the methodological quality of these trials, including significant heterogeneity. The researchers concluded that well-designed randomized controlled trails are still needed to evaluate this commonly used intervention in the pediatric population.4 Benefits for long-term prophylaxis are even less clear in children with low-grade reflux (I–II).5 Furthermore, no randomized controlled trials assess whether prophylaxis prevents the development of new renal scars in children.6

    In addition, a recent systematic review of studies done in children with normal urinary tracts, as well in children with neurogenic bladders, found that the available evidence is of low quality. Only 6 out of 31 potential studies fulfilled the inclusion criteria. These were small (mean sample size was 28), and the quality scores of all 6 trials were low, indicating that the evidence may be unreliable.7

    Two of 3 studies done in children with normal urinary tracts demonstrated statistically significant higher rates of UTI recurrence in control groups compared with treatment groups receiving 6 to 10 months of either nitrofurantoin or cotrimoxazole (RR=24–31). The third study showed no difference between groups.

    One of 2 trials in children with neurogenic bladder demonstrated higher recurrence rates of 2.9 per 10 patient years for patients receiving antibiotics compared with 1.5 in the untreated group. The other study showed lower recurrence rates of 17.1 for patients receiving antibiotics, compared with 33 in the untreated group.7Neither of these findings were statistically significant.

    A different meta-analysis of 15 controlled clinical trials in children with neurogenic bladder due to spinal cord dysfunction. This analysis showed that antibiotic prophylaxis was associated with a reduction in asymptomatic bacteruria among children with acute spinal cord injury (P<.05), but there was no significant reduction in symptomatic infections. Prophylaxis resulted in an approximately twofold increase in antimicrobial-resistant bacteria. The researchers concluded that although a clinically important effect has not been excluded, the regular use of antimicrobial prophylaxis for most patients who have neurogenic bladder caused by spinal cord dysfunction is not supported at this time.8

    Poor compliance may be an issue with long-term prophylaxis and may represent patient or parent practice.9One study found that in children taking low-dose trimethoprim, 97% of the parents reported giving antibiotics on daily basis, but in 31% of subjects, trimethoprim was not detectable in the urine.6Risk of prophylaxis includes nausea, vomiting, and rash in 8% to 10% of patients; development of resistant organisms; and change in indigenous microflora.6 One study of resistance found that children who received antibiotics for more than 4 weeks in the previous 6 months were more likely to have resistant Escherichia coli isolates than children who had not received prolonged antibiotic treatment (odds ratio [OR]=13.9; 95% CI, 8.2–23.5). Children with abnormalities of the genitourinary tract were approximately 4 times more likely to have resistant isolates of E coli than children without abnormalities of the genitourinary tract (OR=3.9; 95% CI, 2.7–5.7).11

    reference
    Hellström A, Hanson E, Hansson S, Hjälmås K, Jodal U. Association between urinary symptoms at 7 years old and previous urinary tract infection. Arch Dis Child. 1991 Feb;66(2):232–234. [PubMed]

    # Jodal U, Lindberg U. Guidelines for management of children with urinary tract infection and vesico-ureteric reflux. Recommendations from a Swedish state-of-the-art conference. Swedish Medical Research Council. Acta Paediatr Suppl�9;88:87�
    # Elder JS, Peters CA, Arant BS Jr ,爀t al. Pediatric Vesicoureteral Reflux Guidelines Panel summary report on the management of primary vesicoureteral reflux in children. J Urol�7;157:1846�1.
    # Practice parameter: the diagnosis treatment and evaluation of the initial urinary tract infection in febrile infants and young children. American Academy of Pediatrics. Committee on Quality Improvement. Subcommittee on Urinary Tract Infection. Pediatrics�9;103:843�.
    avatar
    monchRN

    Posts : 20
    Join date : 2007-11-15
    Age : 33
    Location : Philippines

    By: Raymond C. Ursal

    Post  monchRN on Tue 18 Aug 2009, 12:38 am

    Answer:

    Drink cranberry juice which helps acidify the urine and increase fluid intake. The client should have urine culture examination if there are symptoms of UTI for proper treatment.

    Urinary Problems in Women
    L. French, MD et. al.

    According to the article, UTI is the most common urinary problem of the women which is manifested by the presence of microbial pathogens in the urinary tract with associated symptoms and usually refers to cystitis. The client may also experience fever and flack pain because of the infection in the upper urinary tract, specifically pyelonenephritis. Complications may lead to renal damage and increased morbidity, especially renal abscess and urosepsis. Recurrent UTI can occur in at least two episodes within a 6 month period or three episodes within a 12 month period.


    Statistically the article states that 25% of young women who have UTI will have a recurrence within 6 months. And it is advice to have a urine cultures if the client is experiencing recurrent signs and symptoms within 6 months to confirm the presence of UTI and to test for sensitivity to antibiotics. Cranberry juice or tablets containing proanthocyanidin as a formed of osmotic diuretic can reduce the rate of recurrences of UTI by one half, exercising their effect by inhibiting adherence of E coli but if the microorganism is already established proanthocyanidin is not that effective anymore. Postmenopausal women, vaginal estrogen reduce the number of recurrences of UTI by decreasing the vaginal pH and permitting a vaginal flora. Voiding after sexual intercourse, lactobacillus drinks, and perineal wiping have no evidence of effectiveness for preventive measures. For those client with three or more recurrences annually may offer the option of self treatment and postcoital use of antibiotic prophylaxis is effective for client with recurrences with a temporal relationship to intercourse. Following the proper protocol and intervention of UTI have a high possibility to reduced or eliminate the recurrence.

    Reference:

    L. French, MD et. al., (2007), Urinary Problems in Women, Retrieve on August 17, 2009 from, http://www.mdconsult.com/das/article/body/1454038506/jorg=journal&source=MI&sp=21741977&sid=855361159/N/686301/s0095454308000973.pdf?SEQNO1&issn=0095-4543
    avatar
    rodel_perez_rn

    Posts : 22
    Join date : 2009-06-19

    response to thread

    Post  rodel_perez_rn on Tue 18 Aug 2009, 12:45 am

    Answer to Question 1:

    The incidence of urinary tract infection among children is a common concern. This infection of the urinary tract causes pain during urination in which some children is having repeated bouts. A short course antibiotic therapy may be used to reduce the adverse effects of medications as well at the treatment cost. However, a course of antibiotics longer than a single dose but shorter than the usual 7-10 days might decrease the relapse rate and still provide some of the benefits of a shortened course of antibiotics.

    A study conducted by Hodson, et. Al. (2009) assesses the therapeutic benefit as well as the consequences of a short-course (2-4 days) antibiotic therapy compared to standard duration (7-14 days) oral antibiotic treatment among children with acute UTI. Randomized as well as quasi-random controlled trials were conducted to compare short-course with the standard-course of antibiotic treatment among children ages 3 months to 18 years having culture proven UTI.

    Results of the study revealed that among the 652 children evaluated, there were no significant difference among the frequency of positive urine cultures between the short-course and the standard course antibiotic therapy for UTI in children. There was no significant difference between short and standard duration therapy in the development of resistant organisms in UTI at the end of treatment (one study: RR 0.57, 95% CI 0.32 to 1.01) or in recurrent UTI (three studies: RR 0.39, 95% CI 0.12 to 1.29). A 2-4 day course of oral antibiotics appears to be as effective as 7-14 days in eradicating lower tract UTI in children.

    References:

    Michael M, Hodson EM, Craig JC, Martin S, Moyer VA. Short versus standard duration oral antibiotic therapy for acute urinary tract infection in children. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD003966. DOI: 10.1002/14651858.CD003966

    Answer to Question 2:

    Recurrent urinary tract infections (UTIs) are a major healthcare concern for premenopausal, healthy, sexually active women. A practical approach to the management and prevention of recurrent UTIs should be simple, practical, and cost effective. Low-dose or postcoital antimicrobial therapy can be effective for women with constellations of many recurrent UTIs, but for women with 2 to 4 UTIs per year, the most cost-effective and empowering management strategy is patient-initiated antimicrobial treatment.

    Patton JP, Nash DB, Abrutyn E. Urinary tract infections: economic considerations. Med Clin North Am. 1991;75:495–513.

    Hooton TM, Stamm WE. Diagnosis and treatment of uncomplicated urinary tract infection. Infect Dis Clin North Am. 1997;11:551–581.

    Schappert SM. Ambulatory care visits to physician offices, hospital outpatient departments, and emergency departments: United States, 1996. Vital Health Stat. 1999;13:I–IV. 1–39.

    Rosenberg M. Pharmacoeconomics of treating uncomplicated urinary tract infections. Int J Antimicrob Agents. 1999;11:247–251. discussion 261–264.

    VonDeneb_Vitto

    Posts : 10
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    Age : 30
    Location : Philippines

    Response: UTI Thread

    Post  VonDeneb_Vitto on Wed 19 Aug 2009, 3:52 am

    WHAT IS THE SIGNIFICANT DIFFERENCE BETWEEN A SHORT-TERM AND THE USUAL 7-14DAY ANTIBIOTIC TREATMENT?

    In a meta-analysis of randomized controlled trials done by Michael, et. Al. (2002), revealed that There was no significant difference in the frequency of positive urine cultures between the short (2–4 days) and standard duration therapy (7–14 days) for UTI in children at 0–7 days after treatment and at 10 days to 15 months after treatment. The meta-analysis showed that there was no significant difference between the short and the standard duration therapy in the growth of resistant organisms in UTI at the end of treatment or in recurrent UTI. The meta-analysis stressed that a 2–4 day course of oral antibiotics is as effective as 7–14 days in eradicating lower tract UTI in children.

    Reference:
    Michael, M., Hodson, E.M., Craig, J.C., Martin, S., Moyer, V.A. (2002). Short compared with standard duration of antibiotic treatment for urinary tract infection: a systematic review of randomized controlled trials. Archives of Disease in Childhood (2002). 87:118-123. Retrieved August 18, 2009, from http://adc.bmj.com/cgi/content/full/87/2/118.


    WHAT PROGRAM/INTERVENTION PREVENTS RECURRENT UTI?

    Systematic reviews concluded that no reliable evidence supports the use of cranberry in the treatment or prophylaxis of UTI; nevertheless, a more recent randomized controlled trial demonstrates evidence of cranberry's efficacy in urinary tract infection prophylaxis. The current proposed mechanism of action is the ability of cranberry to prevent bacterial binding to host cell surface membranes.

    In 2001, two studies were published. The first trial of 150 women consisted of 3 sections: (1) cranberry/lingonberry juice; (2) probiotic supplementation with Lactobacillus GG drink; and (3) no intervention for 12 months. Findings show a significant 20% drop in absolute risk of infection in women receiving cranberry compared with no effect in the probiotic-supplementation and no-intervention groups. In a randomized, placebo-controlled trial of 150 women over a 12-month period uncovered that cranberry juice and cranberry extract tablets greatly diminished the quantity of patients having at least one symptomatic UTI per year.

    Reference:
    Lynch, Darren (2004). Cranberry for Prevention of Urinary Tract Infections. American Academy of Family Physicians (2004). 70 (11) 2175-2177. Retrieved August 18, 2009, from http://www.monoselect.it/documents/CranberryeUTI.pdf

    *alexus
    Guest

    UTI

    Post  *alexus on Thu 20 Aug 2009, 4:56 pm

    WHAT IS THE SIGNIFICANT DIFFERENCE BETWEEN A SHORT-TERM AND THE USUAL 7-14DAY ANTIBIOTIC TREATMENT?

    Answer

    The research entitled: Short compared with standard duration of antibiotic treatment for urinary tract infection: systematic reviews of randomised controlled trials confirm that there was no significant difference between short and standard duration therapy for Urinary tract Infection.

    Short compared with standard duration of antibiotic treatment for urinary tract infection: systematic reviews of randomised controlled trials.

    Abstract

    Aims: To compare the effectiveness of short course (2–4 days) with standard duration oral antibiotic treatment (7–14 days) for urinary tract infection (UTI).

    Methods: Meta-analysis of randomised controlled trials using a random effects model. Ten trials were eligible, involving 652 children with lower tract UTI recruited from outpatient or emergency departments. Main outcome measures were UTI at the end of treatment, UTI during follow up (recurrent UTI), and urinary pathogens resistant to the treating antibiotic.
    Results: There was no significant difference in the frequency of positive urine cultures between the short (2–4 days) and standard duration therapy (7–14 days) for UTI in children at 0–7 days after treatment (eight studies: RR 1.06; 95% CI 0.64 to 1.76) and at 10 days to 15 months after treatment (10 studies: RR 1.01; 95% CI 0.77 to 1.33). There was no significant difference between short and standard duration therapy in the development of resistant organisms in UTI at the end of treatment (one study: RR 0.57, 95% CI 0.32 to 1.01) or in recurrent UTI (three studies: RR 0.39, 95% CI 0.12 to 1.29).

    Conclusion: A 2–4 day course of oral antibiotics is as effective as 7–14 days in eradicating lower tract UTI in children.
    Referrence:

    M Michael, E Hodson, J Craig, S Martin, and V Moyer:Systematic reviews of randomised controlled trials. Arch Dis Child. 2002 August; 87(2): 118–123.
    doi: 10.1136/adc.87.2.118.

    WHAT PROGRAM/INTERVENTION PREVENTS RECURRENT UTI?

    Answer:

    New research funded by the National Institutes of Health suggests that a woman's blood type may play a role in her risk of recurrent UTIs. Bacteria may be able to attach to cells in the urinary tract more easily in those with certain blood factors. Additional research will determine if such an association exists and whether it could be useful in identifying people at risk of recurrent UTIs.

    Studies have found that children and women who tend to get recurrent urinary tract infections are likely to lack infection-fighting proteins called immunoglobulins. Children and women who do not get UTIs are more likely to have normal levels of immunoglobulins in their genital and urinary tracts. However, even most patients who get frequent UTIs have normal immune systems.

    Vaccines are being developed to help patients build up their own natural infection-fighting powers. Vaccines that are prepared using dead bacteria do not spread like an infection; instead, they prompt the body to produce antibodies that can later fight against live organisms. Researchers are currently testing injection and oral vaccines as well as vaccine suppositories that are placed in the vagina.

    Referrence:
    National Women's Health Resource Center Inc. (NWHRC).

    YangChunHua

    Posts : 20
    Join date : 2009-06-23

    Re: UTI THREAD

    Post  YangChunHua on Fri 21 Aug 2009, 2:14 am

    Answer: 2. WHAT PROGRAM/INTERVENTION PREVENTS RECURRENT UTI?

    The benefit of prophylactic antibiotics for the prevention of recurrent UTI in children remains unclear because of underpowered and suboptimally designed trials, but these studies suggest that any benefit is likely to be small, and clinical significance may be limited. The trials of complementary interventions (vitamin A, probiotics, cranberry, nasturtium and horseradish) generally gave favourable results but were not conclusive. Children and families who use these products should be aware that further infections are possible despite their use.

    Urinary tract infection (UTI) in children is common (5-10%) and recurs in 10-30%. UTI causes an unpleasant, usually febrile illness in children. This review focuses on studies evaluating interventions to prevent UTI in children and published between January 2007 and June 2008.
    Recent findings: Three relevant updated Cochrane reviews, six randomized trials and an evidence-based guideline were published in the study period. Five of the six trials and one of the three Cochrane updates included data on the effects of relevant interventions in children. Three of the six trials investigated the efficacy of long-term, low-dose antibiotics as prophylaxis, and the other trials and both Cochrane updates evaluated complementary therapies such as vitamin A, probiotics and herbal supplements.
    Reference:
    http://journals.lww.com/co-infectiousdiseases/Abstract/2009/02000/Prevention_of_recurrent_urinary_tract_infection_in.12.aspx
    avatar
    yachen

    Posts : 12
    Join date : 2009-06-25

    Re: UTI THREAD

    Post  yachen on Fri 21 Aug 2009, 5:28 am

    answer 1:

    There is no significant difference between a short-term and the usual 7-14 day antibiotic treatment. Short- term antibiotic treatment appears to be as effective as 7-14 days in treating UTI. This is supported by the study made by Selma Mizouni, M.D 2006

    Report by: Selma Mizouni, M.D
    Institution: EVMS
    Date submitted: November 27th 2006
    Three Part Question:
    P: In a patient with acute UTI symptoms
    I: Is a three days of oral ABX
    C: Compared to five or seven days
    O: Associated with lower cure rate?
    Clinical scenario
    A 42 years old woman diagnosed with a uncomplicated UTI and you want to prescibe a antibiotic. You
    wonder whether a short 2-3 day course is better than longer 7-14 day course of antibiotics.
    Search strategy
    Medline database 1966 to present.
    The Cochrane Library 2006
    Search outcome
    Five metanalysis were identified as answering the 3 part question, found also in Cochrane
    Urinary tract infection (UTI) refers to the presence of a certain threshold number of bacteria in the
    urine.
    Bacterial cystitis (bacteria in the bladder, also called acute cystitis) can occur in men and women
    and the signs and symptoms include dysuria (pain on passing urine), frequency, cloudy urine,
    occasionally haematuria (blood in the urine), and is often associated with pyuria (high urine white
    blood cell count).
    Complicated UTIs are those associated with fever and/or back pain (indicating kidney infection),
    UTIs in men, UTIs associated with indwelling or intermittent urinary catheters, obstructive
    uropathy (any changes in the urinary tract due to obstruction), vesicoureteric reflux (urine travels
    from the bladder back up toward the kidneys) and other urological abnormalities.

    Comment(s)
    This review addresses the three-part question directly and concludes that a short course of treatment is an
    effective choice in the treatment of childhood UTI and uncomplicated UTI.
    Clinical bottom line
    1. 3 days of ABX in uncomplicated UTI in women 18-65 is sufficient.
    2. 3 days of ABX in uncomplicated UTI in children 3 months-3 years is sufficient.
    3. The verdict is still out there for pregnant woman. Treat for 5-7 days until new data.
    4. Treat elderly woman with uncomplicated UTI with a short course of ABX. One single dose is not
    yet acceptable despite the benefits of reducing side effects.
    5. Anyone with a complicated UTI should get a longer course of ABX.
    References
    1. Michael M, Hodson EM, Craig JC, Martin S, Moyer VA Short versus standard duration oral
    antibiotic therapy for acute urinary tract infection in children (Review) The Cochrane Database of
    Systematic Reviews 20 January 2003, Issue 1. Art. No.:CD003966.DOI:
    10.1002/14651858.CD003966
    2. Milo G, Katchman EA, Paul M, Christiaens T, Baerheim A, Leibovici L Duration of
    antibacterial treatment for uncomplicated urinary tract infection in women Milo G,
    Katchman EA, Paul M, Christiaens T, Baerheim A, Leibovici LThe Cochrane Database of
    Systematic Reviews 2006 Issue 4 Copyright © 2006 The Cochrane Collaboration
    3. Treatments for symptomatic urinary tract infections during pregnancy Vazquez JC, Villar J
    4. Antibiotics for preventing recurrent urinary tract infection in non-pregnant womenAlbert
    X, Huertas I, Pereiró I, Sanfélix J, Gosalbes V, Perrota C
    5. Antibiotic duration for treating uncomplicated, symptomatic lower urinary tract infections
    in elderly women Lutters M, Vogt-Ferrier NB



    answer 2:
    PURPOSE OF REVIEW: Urinary tract infection (UTI) in children is common (5-10%) and recurs in 10-30%. UTI causes an unpleasant, usually febrile illness in children. This review focuses on studies evaluating interventions to prevent UTI in children and published between January 2007 and June 2008. RECENT FINDINGS: Three relevant updated Cochrane reviews, six randomized trials and an evidence-based guideline were published in the study period. Five of the six trials and one of the three Cochrane updates included data on the effects of relevant interventions in children. Three of the six trials investigated the efficacy of long-term, low-dose antibiotics as prophylaxis, and the other trials and both Cochrane updates evaluated complementary therapies such as vitamin A, probiotics and herbal supplements. SUMMARY: The benefit of prophylactic antibiotics for the prevention of recurrent UTI in children remains unclear because of underpowered and suboptimally designed trials, but these studies suggest that any benefit is likely to be small, and clinical significance may be limited. The trials of complementary interventions (vitamin A, probiotics, cranberry, nasturtium and horseradish) generally gave favourable results but were not conclusive. Children and families who use these products should be aware that further infections are possible despite their use.

    nancelle
    Guest

    UTI THREAD

    Post  nancelle on Fri 21 Aug 2009, 2:33 pm

    Nancelle Grace G. Dumlao


    UTI THREAD

    1. WHAT IS THE SIGNIFICANT DIFFERENCE BETWEEN A SHORT-TERM AND THE USUAL 7-14DAY
    ANTIBIOTIC TREATMENT?

    2. WHAT PROGRAM/INTERVENTION PREVENTS RECURRENT UTI?

    ANSWER 1:

    WHAT IS THE SIGNIFICANT DIFFERENCE BETWEEN A SHORT-TERM AND THE USUAL 7-14DAY ANTIBIOTIC TREATMENT?


    The choice of antibiotic to treat UTI may depend on the type of UTI, age of the patient, other illnesses of the patient (contraindications to certain drug) or even preference of the physician. The possible therapeutic alternatives are (Gilbert, 2000).
    • uncomplicated UTI (cystitis or urethritis) : orally twice a day for three days of either one of these : BactrimDS, Ciprofloxacin ( 250mg) , Norfloxacin (400mg), Ofloxacin ( 200mg), Levofloxacin (250mg), or Augmentin (875md)
    • recurrent cystitis (more than 3x/year): follow the regimen above then start long term maintenance therapy with Bactrim single-strength one tablet once daily.
    • Complicated UTI: Ampicillin 1 gram IV every 6 hours + Gentamycin IV or Ciprofloxacin 200-400mg IV every 12 hours or Levofloxacin 250 to 500mg IV qd or Piperacillin-tazobactam 3.375 grams IV every 6 hours or Imipenem 500mg IV q6h
    • Gonococcal urethritis : ceftriaxone or levofloxacin and azithromycin for 7 days
    • Non-gonococcal urethritis (Chlamydia) : azithromycin or doxycycline for 7 days
    • Recurrent or persistent urethritis : metronidazole and erythromycin for 7 days

    However, the effectiveness of using a 3-day or 7 to 14-day regimen of antibiotic therapy remains to be a controversy to many due to unsupported studies on UTI and antibiotic treatment. In one study, Trimethoprim–sulfamethoxazole is the preferred choice for empirical therapy in younger women (McIsaac, et al, 2002) but for elderly patients, it causes increasing resistance.
    Hence, in another study by Vogel and colleagues (2004) they aimed to discover the optimal duration antibiotic therapy for older women with uncomplicated UTI.

    In their study, a total of 183 women (65 y/o and older) with acute uncomplicated UTI from various hospitals were asked to join the study. They were dividend into 2 control groups and randomly assigned to receive either ciprofloxacin 250 mg twice daily orally for 3 days followed by placebo for 4 days (the 3-day group, 93 patients) or ciprofloxacin 250 mg twice daily orally for 7 days (the 7-day group, 90 patients). Ciprofloxacin was used for this study was due to its efficacy against most uropathogens seen in older generations and its low bacterial resistance which limited the exclusion of subjects during the study period. However, excluded are patients with urinary tract abnormalities, pyelonephritis, diabetes mellitus, contraindications to fluoroquinolones, and recent use of antibiotics.

    Effectiveness of the antibiotic regimen were tested by requesting urinalysis and urine culture for all participants on day 5 and day 9 after initiation of treatment. Midstream catch or catheterization by qualified nurses and staff were done to ensure sterility of urine sample. Reinfection and relapse were determined 6 weeks after therapy using urine culture.

    In summary, the study revealed that 3-day antibiotic regimen for uncomplicated symptomatic UTI in women 65 years and above have similar efficacy to a longer and more standardized 7-day therapy and with lesser adverse events. Since the target patients are older women, the shorter duration egimen is more beneficial in terms of better compliance, lesser side effects. On the other hand, they emphasized that their results do not extended to the frail elderly population with significant comorbidities who have UTI.


    Reference:

    Vogel, T., Verreault, R., Gourdeau,M., Morin,M., Grenier-Gosselin , L., and Rochette, L. Optimal duration of antibiotic therapy for uncomplicated urinary tract infection in older women: a double-blind randomized controlled trial. Canadian Medical Association . February, 2004.

    Gilbert DN, Moellering RC, Sande MA. The Sanford Guide to Antimicrobial Therapy 2000. 30th ed. Hyde Park,VT: Antimicrobial Therapy, Inc.; 2000


    ANSWER 2:

    WHAT PROGRAM/INTERVENTION PREVENTS RECURRENT UTI?


    The accepted treatment for recurrent UTI is either repeated antibiotic therapy or low-dose long-term antibiotics prophylaxis. However, the continued use of antibiotics is gradually losing its appeal due to concerns in antimicrobial resistance and other issues such as super-infection with Clostridium difficile. Moreover, there are more people who recognize the benefits of using cranberry products in preventing the recurrence of UTI in women. In the hope of further strengthening the role of cranberry juice in preventing UTI, the group of McMurdo (2008) undertook this study below.
    This study attempted to compare the effectiveness and acceptability of low-dose trimethoprim with cranberry products in the prevention of recurrent UTI in older women. Its participants involve 137 women with 2 or more antibiotic-treated UTIs in the last 12 months and they randomly asked to take 500mg of cranberry extract or 100mg of trimethoprim for 6 months. Excluded are those who already take cranberry juice, those with prior urological surgery, with DM, and those with stones or anatomical abnormalities in the urinary tract. Diagnostics used to ascertain effectiveness of treatment were urinalysis and urine culture. Adherence to therapy was encouraged by home visits, capsule counting and telephone follow-ups. Cranberry extract used instead of juice because they have the same efficacy based on previous studies, the capsules are cheaper and more convenient as compared to the juice and may contribute to better compliance.

    Results of the study are as follows: 39 patients (28%) had an antibiotic-treated UTI (25 in the cranberry group and 14 in the trimethoprim group). There was no significant difference in terms of the time of first recurrence of UTI between the groups (P = 0.100). The median time to recurrence of UTI was 84.5 days for the cranberry group and 91 days for the trimethoprim group (U = 166, P = 0.479).

    In summary, their study revealed that trimethoprim had a very limited advantage over cranberry extract in the prevention of recurrent UTIs in older women and had more adverse effects. This will give older women with recurrent UTIs another option which is to utilized cheap, natural cranberry extract with no risk of antimicrobial resistance or super-infection with Clostridium difficile or fungi.

    Reference:

    McMurdo,M.E., Argo, I., Phillips, G., Daly, F., and Davey, P. Cranberry or Trimethoprim for the Prevention of Recurrent Urinary Tract Infections? A randomized Controlled Trial in Older Women. Journal of Antimicrobial Chemotherapy July,2 008. 63(2):389-395; doi:10.1093

    Lucy Yuan

    Posts : 15
    Join date : 2009-06-23

    Re: UTI THREAD

    Post  Lucy Yuan on Fri 21 Aug 2009, 9:44 pm

    ANSWER QUESTION 1:
    There is no significant difference between a short-term and the usual 7-14 day antibiotic treatment. Short- term antibiotic treatment appears to be as effective as 7-14 days in treating UTI.
    TILE:Short compared with standard duration of antibiotic treatment for urinary tract infection: a systematic review of randomised controlled trials
    M Michael, E Hodson, J Craig, S Martin, and V Moyer
    Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.



    ANSWER QUESTION 2:
    Evidence is insufficient to recommend for or against antibiotic prophylaxis to prevent recurrent urinary tract infections (UTI) in children with anatomic abnormalities. Guidelines acknowledge this lack of evidence, but still recommend using prophylactic antibiotics in children with vesiculoureteral reflux (strength of recommendation: B, based on poor-quality or inconclusive cohort and randomized controlled studies).1-3 No controlled, prospective studies have examined the effectiveness of prophylactic antibiotics to prevent UTI recurrence or renal scarring.

    TITLE:Prevention of recurrent urinary tract infection in children.Williams G, Craig JC.
    Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia. gabriew4@cw.edu.au

    PURPOSE OF REVIEW: Urinary tract infection (UTI) in children is common (5-10%) and recurs in 10-30%. UTI causes an unpleasant, usually febrile illness in children. This review focuses on studies evaluating interventions to prevent UTI in children and published between January 2007 and June 2008. RECENT FINDINGS: Three relevant updated Cochrane reviews, six randomized trials and an evidence-based guideline were published in the study period. Five of the six trials and one of the three Cochrane updates included data on the effects of relevant interventions in children. Three of the six trials investigated the efficacy of long-term, low-dose antibiotics as prophylaxis, and the other trials and both Cochrane updates evaluated complementary therapies such as vitamin A, probiotics and herbal supplements. SUMMARY: The benefit of prophylactic antibiotics for the prevention of recurrent UTI in children remains unclear because of underpowered and suboptimally designed trials, but these studies suggest that any benefit is likely to be small, and clinical significance may be limited. The trials of complementary interventions (vitamin A, probiotics, cranberry, nasturtium and horseradish) generally gave favourable results but were not conclusive. Children and families who use these products should be aware that further infections are possible

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