Overview: Urinary Tract Infection

• Urinary tract infections (UTIs) are common, with an estimated lifetime incidence of approximately 53% in women and 14% in men.

• The higher prevalence in women is thought to be related to urethral length.

• For those who have had a prior infection, the risk of another increases dramatically.

• One study found a recurrence rate of 44% within 1 year for those women with a history of UTI.

• The most common pathogens include gram-negative organisms, in particular Escherichia coli (E. coli), which accounts for 80% of infections.

• Many recurrent infections may actually represent reinfection with the same organism.

• Despite clearing the bacteria from the urine, the colon may act as a reservoir for pathogenic bacteria.

Risk Factors for Urinary Tract Infection

Important Points to Consider

• d-Mannose is thought to inhibit urinary tract infection by encouraging binding of bacteria to this sugar instead of the bladder wall and thus enhancing evacuation through the urine.

• Many cranberry beverage products on the market contain only a small amount of cranberry juice and a significant amount of sweeteners. This may have a minimal impact on the urinary tract and potentially a negative impact on overall health.

  
  

Prevention Prescription: Urinary Tract Infection

• Encourage a plant-based diet high in garlic and onions.

• Urge removal of possible bladder irritants such as caffeine, alcohol, and simple sugars.

• Encourage adequate fluid intake. Monitor stress, and focus on foundations of health such as optimal diet, physical activity, sleep.

• Mental and spiritual health.

• Encourage frequent voiding and avoidance of holding urine.

• Consider changing method of birth control if frequent UTIs occur after use of spermicides, condoms, or diaphragms.

• Recommend urination after intercourse.

Therapeutic Review

This is a summary of therapeutic options for UTI both for acute treatment and for prevention. If a patient presents with severe symptoms or has a history suggestive of a complicated UTI, an initial course of antibiotics would be beneficial. For the patient who has mild to moderate symptoms, a ladder approach may be appropriate. Patients should be counseled to seek further care if their symptoms worsen or do not resolve.

Acute Infection

Nutrition

• Encourage garlic consumption.

Supplements

• D-Mannose: ¼ to 1 teaspoon three times daily

Botanicals

• Cranberry 16 oz of unsweetened juice daily or extract 500 mg bid

• Uva ursi: hydroquinone derivative 400-840 mg up to 4 times daily or 3 grams of dried root daily

Pharmaceuticals

• Trimethoprim-sulfamethoxazole: one double-strength tablet twice daily for 3 days

• Nitrofurantoin extended release: 100 mg twice daily for 7 days

• Ciprofloxacin: 250 mg twice daily for 3 days

• Phenazopyridine: 200 mg twice daily for 2 days

Recurrent Infections

Removal of Exacerbating Factors

• Eliminate use of spermicides, and try a change of birth control method.

• Recommend urinating after intercourse.

Nutrition

• Encourage garlic consumption.

• Encourage adequate fluid intake.

Supplements

• Probiotics: 1 billion CFUs daily of Lactobacillus rhamnosus or L. fermentum

• Vitamin C: 100 mg daily

Botanicals

• Cranberry: 16 oz of unsweetened juice daily or extract, 500 mg twice daily

• Uva ursi

• Other herbal products that have potential benefit, including berberine-containing plants and echinacea

Pharmaceuticals

• Trimethoprim-sulfamethoxazole: one double-strength tablet daily

• Nitrofurantoin: 100 mg daily

• Ciprofloxacin: 250 mg daily

Other Therapies

• Biofeedback for those with dysfunctional voiding

• Acupuncture

Key Web Sources

• National Center for Complementary and Alternative Medicine (NCCAM) Dietary and Herbal Supplements page. http://nccam. nih.gov/health/supplements

• National Kidney and Urologic Diseases Information Clearinghouse. http://kidney.niddk.nih.gov/index.htm