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General Information & Practitioner Guidelines for Urinary Tract Infections

Urinary tract infections (UTIs) are among the most common infections in the US, second only to upper respiratory tract infections. It is estimated that UTIs account for five to eight million physician visits each year. About one in two women will experience a UTI at least once during her lifetime. In addition, it has been estimated that four out of five women who have a UTI will have a recurrence within 12 to 18 months, usually because they are anatomically predisposed to such conditions. The costs of treating these infections are enormous, totaling over $1 billion a year, and patients typically lose at least one day of work. (1,2)

What are the symptoms of an uncomplicated UTI? (1)
Although some uncomplicated UTIs (acute cystitis) do not produce symptoms, in general, symptoms of uncomplicated UTIs include:

• An intense urge to urinate
• An increased frequency of urination, even if only a few drops of urine are passed
• Burning or stinging during urination
• Cloudy or malodorous urine, or urine tinged with blood
• Pain in the pubic area

Who is at risk for uncomplicated UTIs? (3)
Most uncomplicated UTIs occur in otherwise healthy, and sexually active, women. Contamination of the urinary tract occurs more often in women than in men, because the urethra is shorter and closer to the sources of bacteria, the anus and the vagina. However, children and men can also contract UTIs, which tend to be considered complicated UTIs.

Additional factors that make people "at risk" for UTIs include:

• A history of diabetes, sickle-cell anemia or other disorders that weaken the immune system, abuse of analgesics and kidney stones usually are associated with increased rates of infection
• Studies show that risk of infection increases with sexual intercourse and diaphragm and spermicide use
• Women who are pregnant are susceptible to UTIs due to hormonal changes or shifts in the positioning of the urinary tract during pregnancy
• In menopausal or post-menopausal women, loss of estrogen and a thinning vaginal and urethral lining can also increase the risk of UTIs
• Elderly people are at risk for UTIs since often times they become critically ill and/or lose bladder control and require the use of catheter, a common source for infection
• Other causes may include consumption of alcohol or caffeine, not drinking enough liquids and urinating infrequently

How to treat uncomplicated UTIs (1,4-6,9)
A doctor can diagnose an infection through a simple urinalysis, which detects the presence of white blood cells in the urine. The most common treatments for uncomplicated UTIs are oral antibiotics, although for severe pain, doctors may prescribe phenazopyridine to ease the pain. Antibiotic use ranges from single-dose therapy to a three-, seven- or 10-day course. There are various antibiotics that can be used to treat UTIs, and most symptoms disappear within a few days after starting treatment with the antibiotic. Several factors determine which antibiotics physicians prescribe, including effectiveness, cost, side effects and the possibility that the antibiotic could contribute to the development of bacterial resistance in serious infections. Some treatment guidelines for physicians and patients include:

• The use of broad spectrum antibiotics to treat simple infections, such as uncomplicated UTIs, may lead to the development of resistance in the treatment of more serious infections. It is for this reason that some experts advise reserving broad spectrum antibiotics for more serious infections and using narrow spectrum antibiotics.
• Physicians should take the time to speak with patients about the rationale for the use, or non-use, of antibiotics. If an antibiotic is prescribed, physicians should explain how to properly use the antibiotic and the importance of patient adherence to these instructions.
• Antibiotics should be taken exactly as directed and continued until the prescription is completed, even if symptoms disappear, to allow all of the bacteria to be killed.
• Before antibiotics begin to take effect, some discomfort can be eased with a heating pad or a warm bath.
• Drink fluids in order to flush out bacteria from the urinary tract. Drinking cranberry juice may interfere with bacterial adherence to the bladder wall, enhancing bacterial eradication.

How to prevent UTIs (7-8)

• Practice good hygiene. Wiping from front to back after urination or a bowel movement will avoid the spread of bacteria from the rectum to the urethra. Urinating frequently is also recommended so that the bladder stays empty.
• Avoid perfumed products. The use of bubble bath or perfumed soaps in the vaginal area may increase the risk of UTIs. Mild detergents are recommended for washing clothes in individuals who are allergy sensitive. In addition, doctors usually recommend that women avoid douches and feminine hygiene deodorants. Tampons and sanitary napkins should be changed frequently during menstruation.
• Wear loose, cool clothing. Tight clothing can trap moisture and promote bacterial growth. It is recommended that women wear cotton underwear, which allows air to circulate, and loose clothing.
• Practice proper sexual habits. A woman's risk of developing a UTI may be lowered by washing the external genital area before participating in sexual intercourse, and urinating after sexual intercourse. Diaphragms should be the correct size and properly fitted. Women susceptible to UTIs should also consult their doctor about finding alternatives to spermicides.
• Drink six to eight glasses of water a day. This dilutes the urine, flushes bacteria from the urinary tract, and helps ease symptoms.
• Live a healthy lifestyle. Tension, fatigue and a poor diet can all affect the immune system, contributing to the risk of infection.

References

1. American Medical Association website. <www.AMA.org>
2. Alliance for the Prudent Use of Antibiotics web site. <wwww.APUA.org>
3. Gelernter CQ. 1997. Urinary Tract Infections: There are gaps in understanding how to prevent this ailment, which is probably even more common than thought. Seattle Times, Feb. 19, 1997.
4. 1998. Urinary tract infections. Hippocrates 12(4): 9-10.
5. Iowa Women's Health Center web site.
6. 1998. Urinary tract infections. Hippocrates 12(4): 9-10.
7. Kramer Laboratories web site.
8. Levy SB. 1998. Multidrug resistance-a sign of the times. New England Journal of Medicine 338(19):1376-1378.
9. Levy SB. 1998. The challenge of antibiotic resistance. Scientific American 278(3):32-39.

Published 11/99