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Cut Urinary Tract Infection Risks

Antibiotic-resistant bacteria are behind many recurrent UTIs. What can a woman do to reduce risks?

Antibiotic Resistance: Why Your UTI Risks Are Rising continued...

Particularly worrisome: a more than 21% resistance rate to the antibiotic trimethoprim-sulfamethoxazole.

Trimethoprim-sulfamethoxazole "has been the workhorse for treating uncomplicated urinary tract infections for many years," says Stamm. It's disturbing to see resistance rates rise so high in some communities, he says. "When resistance gets up to 20%, you consider another antibiotic."

Fortunately, doctors have been able to prescribe an alternative group of antibiotics called fluoroquinolones. Yet now they're starting to see resistance in some fluoroquinolones, too. For example, the Manitoba researchers found that ciproflaxin (Cipro), had a 5.5% resistance rate, and levofloxacin (Levaquin), a little over 5%.

With recurrent urinary tract infections, urine analysis and testing becomes crucial for effective treatment. "Urine cultures are usually indicated in managing women with recurrent UTI," Stamm says. "It's useful to determine the susceptibility to antibiotics since these women often have more resistant strains."

If women don't take the full course of antibiotics as prescribed -- perhaps because they start to feel better -- the infection may return. Stopping the drug too soon also encourages development of resistant bacteria.

Preventing Recurrent Urinary Tract Infections

Women with recurrent UTIs can cut their risk with a few practical tips:

  • Drink more liquids, especially water, to help flush out bacteria.
  • Drink unsweetened cranberry juice daily.
  • Urinate more often.
  • Empty your bladder shortly after sex.
  • After urination or a bowel movement, wipe from front to back.
  • Avoid spermicide use with a diaphragm; spermicides increase risk of urinary tract infections.
  • Take showers instead of baths.
  • Avoid feminine hygiene sprays, douches, and powders.

Women may also want to ask their doctor about trying the following drug methods for UTI prevention:

  • Taking a single dose of antibiotic after sex. This is especially useful for women who notice that urinary tract infections often start after intercourse, Stamm says.
  • Starting a one- or two-day course of antibiotics as soon as symptoms appear. This requires a woman to keep a prescription or drugs at home. "That's pre-emptive therapy," Stamm says. "You can let the infection start and nip it in the bud."

Scientists are looking for innovative ways to prevent recurrent urinary tract infections. For example, Stamm says that some researchers are studying use of vaginal suppositories containing Lactobacillus.

That's because some urinary tract infections may spring from loss of normal Lactobacilli in the vagina, which allows harmful E. coli to flourish and spread to the urethra. Lactobacillus-replacement therapy may help thwart E. coli. Other researchers are hard at work developing and testing UTI vaccines.

How Cranberries Help

It's also no secret that researchers have been intrigued with cranberries. While data have been mixed, Stamm says, there's enough evidence of benefit that he recommends cranberry juice for patients with recurrent UTIs.

When Camesano had recurrent infections, nurses advised her to drink cranberry juice. "It made a big difference for me," she says. Enough to prompt her to turn her professional expertise toward unlocking the secrets that may make the little red berry a potent ally.

Camesano is now an associate professor of chemical engineering at the Worcester Polytechnic Institute in Massachusetts. Her recent research found that cranberries contain a group of tannins called proanthocyanidins. These tannins alter the shape and membranes of E. coli, making it difficult for the bacteria to attach to the urinary tract and cause a urinary tract infectionurinary tract infection.

That means drinking at least one glass of unsweetened cranberry juice a day may be a good long-term prevention strategy, Camesano says. While it's not clear how long these changes to E. coli last, a steady intake of cranberry juice might prolong the benefits.

"If you're drinking cranberry juice every day, you're going to maximize the chances that your own E. coli are not going to be able to attach to cells in your urinary tract," says Camesano. "I think it's important to be consistent."


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