Updated: Mar 26, 2021
One of the most frequent requests for outpatient consultation is for recurrent urinary tract infections (UTIs) in postmenopausal women.
From a medical view-point, low-dose antibiotics (nitrofurantoin or trimethoprim/ sulfamethoxazole) remain the gold standard in prevention; however, many informed doctors are loathe to prescribe them because of concerns about emergence of resistance, as well as the fact that much of the data showing efficacy are from older studies that were done in times when there was less resistance with some of the key urinary pathogens. Many women now have untreatable UTIs because of antibiotic resistance, so non-antimicrobial measures take increasing precedence over taking drugs.
The first non-microbial treatment is use of topical estrogens which have been proven in at least 2 small randomized controlled trials to reduce urinary tract infections by one third to three quarters, so I have been a strong advocate for having women consider the use of topical estrogen. Women who don’t like topical application can use the estradiol vaginal ring, which can be replaced every 3 months. Estrogen thickens the vaginal wall making it much more resistant to infection.
Now, that is one possibility, and it is nice that we are not giving an antimicrobial agent. What has gotten more press lately, with more trials being conducted, is the use of probiotics. The theory is that probiotics reduce the number of pathogenic gram-negative organisms in fecal flora, and perhaps in vaginal flora as well