Dr. Nosti is a Fellow in Female Pelvic Medicine and Reconstructive Surgery at Washington Hospital Center and Georgetown University Medical Center in Washington, DC.
Kate C. Arnold
Ms. Arnold is a medical student at Georgetown University School of Medicine in Washington, DC.
Cheryl B. Iglesia, MD
Dr. Iglesia is Director of the Section of Female Pelvic Medicine and Reconstructive Surgery at Washington Hospital Center. She is also Associate Professor, Departments of Obstetrics and Gynecology and Urology, at Georgetown University School of Medicine in Washington, DC. She serves on the OBG Management Board of Editors.
One of the natural mechanisms that promotes bacterial elimination and prevents bacterial growth is urination. A recent review article on the subject found several contradictory studies on the effect of fluid intake on the risk of UTI.30 Although there is no definitive evidence that susceptibility to UTI is linked to fluid intake, adequate hydration may reduce the risk of recurrent infection.
Similarly, voiding shortly after sexual intercourse may prevent UTI. One case-control study found a modest protective effect in patients who voided after intercourse.31
Clinical recommendations
Given the low risk of these measures, it seems reasonable to recommend postcoital voiding and increased fluid intake to prevent recurrent UTI.
A focus on symptoms
Phenazopyridine, the chemical found in numerous OTC medications, such as Pyridium, AZO, and Uristat, was discovered by Swiss chemist Bernhard Joos in the 1950s. Its mechanism of action is still unclear, but approximately 65% of the oral dose is excreted by the kidneys, where it has a direct topical analgesic effect.32,33
Clinical recommendations
Patients should be warned that phenazopyridine will lead to orange urine discoloration.
The medication is generally well tolerated but should be used with caution in patients with acute renal failure, hemolytic anemia, or methemoglobinemia, as it may exacerbate these conditions.
Last words
Recurrent UTIs are common and impose a significant financial burden on our healthcare system. Although there are several antibiotic treatment options and dosing regimens available, increasing antibiotic resistance has made management of recurrent UTIs more difficult. Effective alternative treatments that reduce the reliance on antibiotics may minimize bacterial resistance and decrease the financial burden of this common condition.
CASE: Resolved
To reduce vaginal E. coli, the patient is started on vaginal estrogen cream. She is also advised to purchase cranberry tablets to help prevent future infections. Last, she is counseled about behavioral changes she can make and prescribed a short course of antibiotics to treat her culture-proven infection.
