When I work with doctors one of the most read subjects is a look at the medical research surrounding chronic urinary tract infections (UTIs), the problems of antibiotic resistance and whether or not cranberries and probiotics are useful.

UTIs in post-menopausal women

Many of us do not completely understand the threat of anti-bacteria resistance. Simply the more antibiotics we use, the greater proportion of the bacteria will become resistant.

That is what researchers in Norway wrote in their recently published paper How to prevent recurrent urinary tract infections after menopause? Here are summary highlights

  • Recurrent urinary tract infections are defined as three or more cases of urinary tract infections during a year.
  • Postmenopausal women are particularly at risk
  • Antibiotic resistance is a growing problem.

They cite a 2011 study looked at 1,473 nursing home residents who received treatment for urinary tract infection.1

Using this information, researchers then applied dosage recommendations against existing research. This is what they found:

  • Women who were prescribed methenamine had 55-66% recurrence throughout follow-up period, compared with 25-37% in a placebo groups. In other words the antibiotic group suffered more recurrent infections than a group that took a sugar pill.
  • Studies on women who were prescribed local estrogens vaginal inserts were inconclusive, but what data was found seemed to suggest estrogen prescription did not promote reccurance of infections.
  • Studies on women who took oral estrogencould not find benefits.

The cranberry controversy

The same researchers found that they could not make a recommendation for the use of cranberries as  preventative for urinary tract infections in post-menopausal women. They admit this was much different from other research that found cranberries to be effective for UTIs. There was a heavy reliance on a 2011 study which claimed cranberries did not have a benefit.2

Cranberries and probiotics may be useful in urinary tract infections

  • Many women with symptoms of urinary tract infections are choosing to avoid antibiotics

Given the option, many women with symptoms of urinary tract infections are choosing to avoid antibiotics and give their bodies a chance to heal naturally according to research in open access journal BMC Family Practice.3

  • The research shows that 70% of women with symptoms of uncomplicated urinary tract infections who did not use antibiotics for a week were cured or showed improvement.

Antimicrobial-resistant bacteria are already a big problem and the incidence of ‘superbugs’, which are resistant to several  antibiotics, is on the rise. Over use of antibiotics increases the chances of disease causing bacteria developing resistance to antibiotics. Obviously for serious bacterial  infections antibiotics can be a life saver, but they do not work on viruses, and for many minor bacterial infections the body’s own immune system is more than capable of fighting off the invaders on its own.

In this study, based at the University of Amsterdam, women with symptoms of uncomplicated urinary tract infections were asked if they would be willing to postpone taking antibiotics. A third of the women asked were willing to delay treatment and a week later about half of these had still not used antibiotics and more than  two thirds of these were better or had improvement in their clinical condition.

Dr Bart Knottnerus, from the Academic Medical Center of the University of Amsterdam, who led this study commented that “Women may be more receptive to the idea of delaying treatment than is commonly assumed by many clinicians. Given proper observations to simply doing nothing, or giving pain medication instead of an antibiotic, is an effective treatment and one which will reduce the risk of developing antibiotic-resistant bacteria.”

There are numerous studies to support the use of cranberry and probiotic in urinary tract infections and it should be discussed with your physican.4 

Including studies that  suggest dried cranberries may reduce the number of urinary tract infections in susceptible women.5 

Recent research confirms cranberries are beneficial in reduction of urinary tract infections (UTI) in susceptible women. In one study something as simple as one serving of cranberries for two weeks helped reduce or eliminate recurrent UTIs in the 20 test subjects.6 

Quick notes on Estrogen

“Estrogens play a major role on the lower urinary tract physiology and physiopathology both on the urethra and the bladder.”6

“Estrogen deficit in postmenopausal women causes urogenital atrophy, which is responsible for a wide range of urinary disorders (urinary incontinence, urge incontinence, recurrent urinary infections) and genital disorders (prolapse, dispareunya, vaginal dryness). The efficacy of estrogen therapy on urinary incontinence is not yet demonstrated, but it is widely recognized that the topical use of estrogens lowers the risk of recurrent urinary infections and improves urogenital atrophy.” 7

Hopefully now you will have some good information to go and talk to your doctor about the next time you visit for chronic UTIs.

 

1. Bergman J, Schjøtt J, Blix HS. Prevention of urinary tract infections in nursing homes: lack of evidence-based prescription? BMC Geriatr 2011; 11: 69.

2. Barbosa-Cesnik C, Brown MB, Buxton M et al. Cranberry juice fails to contraceptives recurrent urinary tract infection: results from a randomized placebo-controlled trial. Clin Infect Dis 2011; 52: 23 – 30.

3. http://bmcfampract.biomedcentral.com/articles/10.1186/1471-2296-14-71

4. Bruyère F, Boiteux JP, Sotto A, Karsenty G, Bastide C, Guy L, Lavigne JP.Anti-infectious treatments in urology sell over the counter. Prog Urol. 2013 Nov;23(15):1357-64. doi: 10.1016/j.purol.2013.09.002. Epub 2013 Oct 21.

5. Burleigh AE, Benck SM, McAchran SE, Reed JD, Krueger CG, Hopkins WJ. Consumption of sweetened, dried cranberries may reduce urinary tract infection incidence in susceptible women – a modified observational study. Nutr J. 2013 Oct 18;12(1):139. doi: 10.1186/1475-2891-12-139.

6. Gamé X, Rischmann P, Arnal JF, Malavaud B.Role of estrogens in lower urinary tract physiology and physiopathology. Prog Urol. 2013 Jun;23(8):502-10. doi: 10.1016/j.purol.2013.03.012. Epub 2013 Apr 19.

7. 6. Della Martina M, Xodo S, Vogrig E, Rinuncini D, Ganzitti L, Driul L, Fabiani G, Marchesoni D. Hormone replacement therapy and urogenital disease in postmenopausal women. Minerva Ginecol. 2012 Aug;64(4):337-44.

Barry Weiner is a medical ghost writer who is trying to get his own byline going after all these years. Don’t use this information other than as a guide to doing your own research – research is fun – everyone should be a scientist.

 

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