Haims: Urinary tract infections (UTI) – antibiotics and alternatives choices

Respiratory and sinus infections, along with strep throat, are some of the most common reasons for antibiotic use worldwide in the treatment of urinary tract infections (UTIs).

UTIs are caused by microorganisms — usually bacteria — that enter the urethra and bladder, causing inflammation and infection. Generally, a UTI is defined as an infection of the urinary system that may involve the lower urinary tract and/or the lower and upper urinary tracts. UTIs can not only affect the urethra, but the bladder and kidneys as well.

Lower UTI

Lower urinary tract infections occur when the urethra and/or bladder is infected. Most UTIs occur in the lower tract. Symptoms of a lower urinary tract infection often include one or more of the following: cloudy, bloody or bad-smelling urine, urinary incontinence, pain, or a burning sensation when passing urine. Of note, in the elderly, delirium and/or acute confusion can often occur.

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Upper UTI

Upper urinary tract infections generally occur when the ureters (duct by which urine passes from the kidney to the bladder) and kidneys become infected. While this type of UTI typically occurs less frequently, the effects are usually more severe as bacteria have greater potential to enter the bloodstream.

Symptoms of an upper UTI can include fever, nausea/vomiting, and pain in the upper back and flanks. It is not uncommon for such an infection to necessitate admission to a hospital or medical facility.

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In the United States, UTIs are quite common. They account for 6 million to 8 million visits to medical providers a year — 20% of which involve emergency room visits. Approximately 25-40% of women aged 20-40 years have had a UTI and 11% of women over the age of 18 experience at least one episode annually.

Treatment and prevention

While antibiotics are the go-to medicine of choice for UTIs, they do have a downside — repeated use often leads to antibiotic resistance. This is why many medical providers will start treatment with narrow spectrum antibiotics which are less likely to lead to antibiotic resistance and side effects.

When antibiotics are used frequently, resistance to these drugs can occur causing them to be ineffective. Some of the most frequently used antibiotics that treat UTIs are: Cipro, Bactrim, nitrofurantoin and fosfomycin. Recently, a new medication called Pivya was approved by the FDA for use with uncomplicated urinary tract infections. Resistance to such antibiotics is occurring with great frequency. Further, some of these medications may not be optimal for people who have concerns of chronic kidney disease or take blood pressure medication. Natural treatments exist though. According to doctors at the Cleveland Clinic (ranked as one of the leading urology departments in the US) in addition to information provided by the Journal of the American Medical Association (JAMA), there are a number of alternatives to antibiotics.

Alternatives include probiotics, D-mannose, methenamine hippurate, estrogens, intravesical glycosaminoglycans (GAGs), and cranberries. It is not just a wives’ tail, the medical benefits of cranberries cannot be ruled out.

Although you may need to get methenamine Hippurate, estrogens, and intravesical glycosaminoglycans (GAGs) form your medical provider, probiotics and cranberry choices are readily available. However, you need to educate yourself about the efficacy and use of probiotics and cranberry choices.

Should you have interest in trying probiotics, you need to choose one that is resistant to gastric and bile acids in order to reach the intestinal system. Probiotics species containing Lactobacillus are believed to prevent the adherence, growth and colonization of uropathogenic bacteria. Ask your medical provider if this is an option.

Prevention

• Drink at least 6-8 glasses of water a day. Drinking water helps dilute your urine and ensures that you’ll urinate more frequently.
• Apply an estrogen-containing vaginal cream in postmenopausal women to reduce the risk of a urinary tract infection.
• Follow good hygiene practices of the genital area.
• Urinate frequently. This flushes bacteria out of the bladder and may reduce the risk of cystitis in those who are prone to urinary tract infections.
• Change adult diapers frequently and as soon as possible after leakage occurs. This assists in mitigating the reintroduction of bacteria.

While antibiotics must be used with caution in the treatment of UTIs, so should natural alternatives. You should always consult your medical provider when it comes to UTI concerns — a simple infection can become a serious concern.

Judson Haims is the owner of Visiting Angels Home Care in Eagle County. He is an advocate for our elderly in Eagle, Garfield and Pitkin counties and is available to answer questions.