Compounding Pharmacists Can Help Prevent Recurrent Antibiotic Resistant Urinary Tract Infections in Women

Compounding Pharmacists Can Help Prevent Recurrent Antibiotic Resistant Urinary Tract Infections in Women

i-cadeceusAny woman who has experienced a urinary tract infection (UTI) knows how quickly it can progress from no symptoms to either frequent and painful urination or an utter inability to urinate. Either way, it’s often assumed that after a trip to the doctor and a course of antibiotics, individuals are good to go. But it’s not always that easy. Recurrent infections are likely to occur, a problem that’s increasingly associated with antibiotic resistance. Valuable outreach from compounding pharmacists can help women properly treat and prevent recurring UTIs.

Urinary Tract Infections in Women

Urinary tract infections are so common that their potential to cause serious complications like urosepsis tends to be overlooked. For this reason, it’s important to be aware of the size of the problem and its impact on your patients. UTIs are the second most common infection treated by health care providers, representing an estimated 8.6 million office visits, 2 to 5 million trips to the emergency department, and 1 million hospital admissions every year.1 About 84 percent of those patients are women. One-third of your female patients will be diagnosed with a UTI by the time they reach their twenty-fourth birthday. In addition to being female, other risk factors that affect women include:2

  • Prior UTI
  • Sexual activity
  • Vaginal infection
  • Diabetes
  • Treatment with SGLT2 inhibitors
  • Menopause
  • Older age
  • Using diaphragms or spermicides

Recurrent UTIs are also common—25 percent of women will have a recurrence within six months. They’re always advised to practice optimal hygiene habits, such as wipe from front to back, wear cotton underpants, drink six to eight glasses of water daily and urinate after sexual intercourse. Treatment with antibiotics may reduce recurrent UTIs by 95 percent, but then antibacterial resistance increases the risk, setting up a cycle of hard-to-treat recurring UTIs.3

Urinary tract infections are separated into two categories—uncomplicated and complicated. Uncomplicated UTIs affect most healthy women. Complicated UTIs occur in women with structural or neurological abnormalities, although the majority of their infections are attributed to indwelling catheters. Treatment challenges caused by antibacterial resistance affect both groups, but they’re especially problematic in complicated UTIs.

Antimicrobial Resistance in UTIs and the Risk of Urosepsis

Patients and professionals alike don’t usually think of UTIs as deadly, but they’re responsible for 5 to 8 percent of all cases of urosepsis. UTIs may even account for 40 percent of nosocomial infections. Throw in one more statistic—sepsis has an estimated mortality rate of 28 to 50 percent—plus the threat of antibacterial resistance and you can truly appreciate why UTIs should not be shrugged off as routine and easy-to-treat. Treatment for uncomplicated UTIs used to consist of seven to 10 days of antibiotic treatment, but a three-day course is just as effective. Drugs must target Escherichia coli, which is the most common cause of uncomplicated and complicated UTI. E. coli is followed by Klebsiella pneumoniae, Staphylococcus saprophyticus and Enterococcus faecalis.

Medication choices should be based on susceptibility from patient-specific isolate, because resistance varies depending on the geographic region. However, cephalosporin and amoxicillin are generally less effective due to increasing antibiotic resistance to beta-lactam therapies nationwide. Data from 2012 shows that resistance to third-generation cephalosporin reached 16 percent in the mid-Atlantic area and 12 percent in the Pacific and South Atlantic regions.4 The following drugs are recommended:

  • Trimethoprim-Sulfamethoxazole – 160 mg TMP and 800 mg SMZ twice daily for three days.
  • Trimethoprim – 100 mg twice daily for three days.
  • Norfloxacin – 400 mg twice daily for three days.
  • Nitrofurantoin macrocrystals – 50 to 100 mg four times daily for seven days.
  • Nitrofurantoin monohydrate macrocrystals – 100 mg twice daily for seven days.
  • Fosfomycin tromethamine – 3 g (powder) single dose
  • Ciprofloxacin – 250 mg twice daily for three days.
  • Levofloxacin – 250 mg once daily for three days.

While ciprofloxacin and levofloxacin are highly effective for uncomplicated UTIs, they have a higher risk for subsequent infection with more resistant organisms, so they should be reserved as a last choice.5 Resistance to TMP-SMZ is also around the 20 percent mark, which is the point at which another antibiotic should be considered.

How Can Compounding Pharmacists Help Prevent Recurrent Antibiotic Resistant Urinary Tract Infections in Women?

Women with a history of UTIs may recognize the symptoms and may head to the pharmacy for OTC treatments, hoping to avoid a trip to the doctor. Other women may have symptoms and come to you with questions about underactive bladder, overactive bladder, UTIs or painful bladder syndrome. For these patients, as well as those filling prescriptions for antibiotics, compounding pharmacists can help prevent recurrent UTIs by offering this advice:

  • Take the full course: Women who don’t take the full course of antibiotics may encourage the development of resistant bacteria or have a higher risk of recurrence.
  • Prophylactic antibiotics: Patients with infections that start after intercourse may be candidates for taking a single dose of antibiotic after sex, while women with recurrent infections can benefit from pre-emptive drug therapy. These patients need to have a one- or two-day course of antibiotics at home, so recommend that they talk to their physician.
  • Birth control: Recommend that they limit the use of spermicides.
  • Vaginal estrogen cream: May reduce the risk of UTIs in postmenopausal women.6.
  • Urine pH: A higher pH may help resist bacterial growth. Woman may increase alkalinity of their urine by taking calcium supplements.
  • Coffee, tea and wine: The urinary tract releases the antimicrobial protein siderocalin to help fight E. coli.7 Foods rich in polyphenols, such as tea, coffee and wine may stimulate siderocalin, so drinking these beverages may help prevent or treat UTIs.
  • Cranberries: Cranberries are rich sources of proanthocyanidins, which may support siderocalin. These polyphenols also interfere with the ability of bacteria to adhere to the bladder epithelium. Studies have produced mixed results, but cranberries may work for some women without adding to bacterial resistance. Advise your patients to choose products that are 100 percent cranberry juice and low in sugar; alternatively, they can take cranberry tablets or capsules.

Proactive Outreach Can Help Protect Women from UTIs

Whether your patients are dealing with their first UTI or they have a history of recurrent infections, it’s beneficial for them to learn about the dangers of antibacterial resistance, sepsis and the best ways to prevent UTIs. You have the opportunity to reach out when they fill prescriptions, but many of these women are likely to first turn to OTC products, so it’s also a good idea to have staff catch them at the checkout and suggest they talk with the pharmacist. Your efforts have a crucial impact on their long-term health.

Pharmaceutica North America provides high-quality bulk APIs, prescription drug products, custom compounding kits and OTC dietary supplements. We stay up-to-date with the latest levels of antimicrobial resistance and will work with you to determine the best treatments. Contact us today to discuss how we can help you meet the needs of all your patients.

Show 7 footnotes

  1. “Acute, Uncomplicated Urinary Tract Infections,” November 2013, http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/infectious-disease/urinary-tract-infection/
  2. “Urinary Tract Infections: Epidemiology, Mechanisms of Infection and Treatment Options,” May 2015, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4457377/
  3. “Urinary Tract Infections: Causes and Treatment Update,” April 2016, https://www.uspharmacist.com/article/urinary-tract-infections-causes-and-treatment-update
  4. “Resistance to Escherichia coli to Cephalosporins (Third Generation) in 2012,” accessed online June 2016,  http://resistancemap.cddep.org/resmap/c/us/United%20States
  5. “Urinary Tract Infection Organism-Specific Therapy,” February 2015, http://emedicine.medscape.com/article/1976516-overview
  6. “Guidelines for the Diagnosis and Management of Recurrent Urinary Tract Infection in Women,” October 2011, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202002/
  7. “Human Urinary Composition Controls Antibacterial Activity of Siderocalin,” April 2015, http://www.jbc.org/content/290/26/15949
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