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Prevention of recurrent urinary tract infections: bridging the gap between clinical practice and guidelines in Latin America.
Ther Adv Urol 2019 Jan-Dec; 11:1756287218824089TA

Abstract

The branches of the immune system work in concert to defend against pathogens and prevent tissue damage due to excessive inflammation. Uropathogens in general, and uropathogenic Escherichia coli (UPEC) in particular, have evolved a diverse range of virulence mechanisms to avoid detection and destruction by the mucosal immune system of the urinary tract. Research towards a vaccine active against UPEC continues but has yet to be successful. Orally administered immunomodulatory bacterial lysates both stimulate and modulate the immune response in the urinary tract via the integrated mucosal immune system. The 2018 European Association of Urology (EAU) guidelines on treating acute uncomplicated cystitis recommend aiming for rapid resolution of symptoms, reduction of morbidity, and prophylaxis against reinfection. Recommended short-term antibiotic therapy has the advantage of good compliance, low cost, few adverse events, and low impact on bacterial flora. Antibiotic treatment of asymptomatic bacteriuria is only indicated during pregnancy and before invasive interventions. For recurrent infection, prophylaxis using behavioral modification and counseling should be employed first, then nonantibiotic prophylaxis, and, finally, low-dose continuous or postcoital antibiotic prophylaxis. The 2018 EAU guidelines give a strong recommendation for the oral bacterial lysate immunomodulator OM-89. All other nonantibiotic prophylactic strategies require more data, except for topical estrogen for postmenopausal women. For last-resort antibiotic prophylaxis, nitrofurantoin or fosfomycin trometamol are recommended. Guidelines for Latin America are currently being drafted, taking into account the unique ethnicity, availability of medicines, prevalence of antibiotic resistance, and healthcare practices found throughout the region.

Authors+Show Affiliations

Universidad Autónoma del Estado de Hidalgo, Carr. Pachuca - Actopan, Campo de Tiro, 42039, Pachuca de Soto, Mexico.Technische Universität München, Munich, Germany.Universidade de São Paulo, São Paulo, Brazil.Instituto Mexicano de Infectología, Ginecología y Obstetricia, Universidad de Monterrey, Monterrey, Mexico.Instituto Mexicano de Infectología, Ginecología y Obstetricia, Universidad de Monterrey, Monterrey, Mexico.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31105773

Citation

Ortega Martell, José Antonio, et al. "Prevention of Recurrent Urinary Tract Infections: Bridging the Gap Between Clinical Practice and Guidelines in Latin America." Therapeutic Advances in Urology, vol. 11, 2019, p. 1756287218824089.
Ortega Martell JA, Naber KG, Milhem Haddad J, et al. Prevention of recurrent urinary tract infections: bridging the gap between clinical practice and guidelines in Latin America. Ther Adv Urol. 2019;11:1756287218824089.
Ortega Martell, J. A., Naber, K. G., Milhem Haddad, J., Tirán Saucedo, J., & Domínguez Burgos, J. A. (2019). Prevention of recurrent urinary tract infections: bridging the gap between clinical practice and guidelines in Latin America. Therapeutic Advances in Urology, 11, p. 1756287218824089. doi:10.1177/1756287218824089.
Ortega Martell JA, et al. Prevention of Recurrent Urinary Tract Infections: Bridging the Gap Between Clinical Practice and Guidelines in Latin America. Ther Adv Urol. 2019;11:1756287218824089. PubMed PMID: 31105773.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevention of recurrent urinary tract infections: bridging the gap between clinical practice and guidelines in Latin America. AU - Ortega Martell,José Antonio, AU - Naber,Kurt G, AU - Milhem Haddad,Jorge, AU - Tirán Saucedo,José, AU - Domínguez Burgos,Jesús Alfonso, Y1 - 2019/05/02/ PY - 2018/10/09/received PY - 2018/12/03/accepted PY - 2019/5/21/entrez PY - 2019/5/21/pubmed PY - 2019/5/21/medline KW - immunology KW - prophylaxis KW - treatment guidelines KW - urinary tract infections SP - 1756287218824089 EP - 1756287218824089 JF - Therapeutic advances in urology JO - Ther Adv Urol VL - 11 N2 - The branches of the immune system work in concert to defend against pathogens and prevent tissue damage due to excessive inflammation. Uropathogens in general, and uropathogenic Escherichia coli (UPEC) in particular, have evolved a diverse range of virulence mechanisms to avoid detection and destruction by the mucosal immune system of the urinary tract. Research towards a vaccine active against UPEC continues but has yet to be successful. Orally administered immunomodulatory bacterial lysates both stimulate and modulate the immune response in the urinary tract via the integrated mucosal immune system. The 2018 European Association of Urology (EAU) guidelines on treating acute uncomplicated cystitis recommend aiming for rapid resolution of symptoms, reduction of morbidity, and prophylaxis against reinfection. Recommended short-term antibiotic therapy has the advantage of good compliance, low cost, few adverse events, and low impact on bacterial flora. Antibiotic treatment of asymptomatic bacteriuria is only indicated during pregnancy and before invasive interventions. For recurrent infection, prophylaxis using behavioral modification and counseling should be employed first, then nonantibiotic prophylaxis, and, finally, low-dose continuous or postcoital antibiotic prophylaxis. The 2018 EAU guidelines give a strong recommendation for the oral bacterial lysate immunomodulator OM-89. All other nonantibiotic prophylactic strategies require more data, except for topical estrogen for postmenopausal women. For last-resort antibiotic prophylaxis, nitrofurantoin or fosfomycin trometamol are recommended. Guidelines for Latin America are currently being drafted, taking into account the unique ethnicity, availability of medicines, prevalence of antibiotic resistance, and healthcare practices found throughout the region. SN - 1756-2872 UR - https://www.unboundmedicine.com/medline/citation/31105773/Prevention_of_recurrent_urinary_tract_infections:_bridging_the_gap_between_clinical_practice_and_guidelines_in_Latin_America L2 - http://journals.sagepub.com/doi/full/10.1177/1756287218824089?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -