title: [Primary and secondary prevention of urinary tract infections].
abstract: Urinary tract infections (UTI) are among the most frequent bacterial infections in the community and health care setting. Mostly young and, to some extent, postmenopausal women are affected by recurrent UTI (rUTI) defined as ≥3 UTI/year. On the other hand rUTI are frequently found in patients with complicating urological factors, e.g. urinary catheters. Modifiable predisposing factors in uncomplicated rUTI in women are rare. Continuous antibiotic prophylaxis or postcoital prophylaxis, if there is close correlation with sexual intercourse, are most effective to prevent rUTI. Nitrofurantoin, trimethoprim (or cotrimoxazole), and fosfomycin trometamol are available as first-line drugs. Oral cephalosporins and quinolones should be restricted to specific indications. Antibiotic prophylaxis reduces the number of uropathogens in the gut and/or vaginal flora and reduces bacterial"fitness". Given the correct indication, the recurrence rate of rUTI can be reduced by about 90%. In postmenopausal patients vaginal substitution of oestriol should be started first. Oral or parenteral immunoprophylaxis is another option in patients with rUTI. Other possibilities with varying scientific evidence are prophylaxis with cranberries or probiotics. The prophylaxis of catheter-associated UTI or asymptomatic bacteriuria should employ strategies which result in a reduction of frequency and duration of catheter drainage of the urinary tract. The currently available catheter materials have only little influence on reducing catheter-associated rUTI.
authors.affiliation: Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Universitätskliniken Gießen und Marburg GmbH, Standort Gießen, Justus-Liebig-Universität, Rudolf-Buchheim-Straße 7, 35392, Gießen, Deutschland. Wagenlehner@AOL.com
authors.forename: F M E
authors.initials: FM
authors.lastname: Wagenlehner
authors.forename: W
authors.initials: W
authors.lastname: Vahlensieck
authors.forename: H W
authors.initials: HW
authors.lastname: Bauer
authors.forename: W
authors.initials: W
authors.lastname: Weidner
authors.forename: K G
authors.initials: KG
authors.lastname: Naber
authors.forename: H J
authors.initials: HJ
authors.lastname: Piechota
mesh_terms: D000892:Anti-Infective Agents, Urinary / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001428:Bacterial Vaccines / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004958:Estradiol / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy; D005260:Female; D006801:Humans; D008297:Male; D008517:Phytotherapy / Q000379:methods; D011322:Primary Prevention; D019936:Probiotics / Q000627:therapeutic use; D055502:Secondary Prevention; D014552:Urinary Tract Infections / Q000209:etiology / Q000517:prevention & control*; D029799:Vaccinium macrocarpon
chemical_list: D000892:Anti-Infective Agents, Urinary; D001428:Bacterial Vaccines; D004958:Estradiol