Presentation Authors: Sanjeev Sharma, Nicholas Raison*, Kamran Ahmed, Vibhash Mishra, London, United Kingdom
Introduction: Urinary tract infections (UTIs) are among the most common bacterial infections, affecting 150 million people globally per year. Resistance to antibiotics is on the rise. The purpose of this review is to assess the literature on non-antibiotic prophylaxis for recurrent UTI, focussing on less recognised strategies, namely vaccination and intravesical therapy.
Methods: Embase, Pubmed and the Cochrane Library were searched from January 2000 to August 2018 for articles on non-antibiotic prophylaxis for recurrent UTIs published in English language. The search was limited to human studies comprising adult subjects (>18 years) with no past medical history of urinary tract or renal disease (such as renal transplantation, spinal cord injury, neurogenic bladder, chronic bladder pain syndrome or overactive bladder). Papers investigating pregnant women were also excluded. The Oxford Centre for Evidence-based Medicine (OCEBM) Levels of Evidence March 2009 was utilised in analysing the literature
Results: Database searching revealed 4109 studies and 124 abstracts were reviewed. There is compelling evidence of the efficacy of intravesical Hyaluronic Acid with or without chondroitin Sulphate for the prevention of recurrent UTI. We provide the evidence with an OCEBM level 1a-. Evidence for intravesical heparin is more limited with an OECBM level 4. We recommend large-scale RCTs are performed before definitive conclusions can be drawn. A number of oral and vaginal vaccines containing bacterial extracts are being tested for the prevention of refractory UTI. However, there is no reported data on the long-term efficacy. Furthermore, many of the included studies had unclear methodology. We award the evidence an OCEBM level 1a-. Urovac is a vaginal suppository containing 10 heat-treated bacterial species including 6 serotypes of E. coli. We award the evidence an OCEBM level 1a. Uromune is a sublingual spray containing the inactivated bacteria. Evidence supporting its use is rated level 2b but a randomised doubleâ€blind placebo-controlled trial is reportedly underway
Conclusions: Recurrent UTI remains a pervasive and morbid condition difficult to manage. New treatments as highlighted in this review help to broaden the armentarium that can be offered to a patient. Formal evidence of the more historic treatments is more lacking in comparison to the newer vaccines that have been developed. However these treatments are supported by the far greater depth of experience on their use and safety. However it is vital in all cases to tailor the treatment to the patients individual needs and wishes.