FOR PROFESSIONAL USE ONLY

Size: px
Start display at page:

Download "FOR PROFESSIONAL USE ONLY"

Transcription

1 Natural Approaches to Women s Health Urinary Tract Infections! FOR PROFESSIONAL USE ONLY Prepared By: Rishma Walji, ND, RAc, PhD CCCEP File # I-P Accreditation Date: November 22, 2016 Expiry Date: November 22, 2017 CEUs 0.5

2 Commercial Disclosure This learning activity has received financial support from WN Pharmaceuticals in the form of program development fees. This learning activity has received in-kind support from WN Pharmaceuticals in the form of logistical support. Disclaimer For Professional Use Only This information is provided for educational purposes only and is not intended for self-diagnosis or self-treatment of a condition that should be interpreted by a qualified health care provider. While the information in this document has been carefully reviewed and reflects current clinical and scientific knowledge, it is subject to change. The Author, Expert Reviewers and Presenter declare no real or perceived conflict with the sponsor company.

3 Instructions Carefully watch this lesson. Complete and submit the on-line quiz. Study each question in the post-test and select the answer which you believe to be most correct. To successfully pass this lesson, a grade of 70% is required. Complete and submit the on-line Program Evaluation form. If you pass, you will receive your Statement of Attendance via or mail for your own records. Introduction Throughout a woman s reproductive life menarche to menopause women face health issues that are specific to their hormones and genetic composition. According to Statistics Canada, women make healthier lifestyle choices and are quicker to react to signs of illness. Women are more likely to consider their health when making food choices as well as complementary and alternative health advice.

4 Learning Objectives Goal: To educate pharmacists on the natural treatment options for urinary tract infections (UTIs). Objectives: After completing this session, the pharmacist should be able to: Summarize the prevalence and etiology of UTIs. Describe the physical, behavioral, and psychological symptoms associated with UTIs. Explain the diet, lifestyle & natural health product options available for the treatment of UTIs. Explain the safety and efficacy of these options. Urinary Tract Infections Case MK is a 36-year-old female who arrives at your pharmacy to fill a prescription for Nitrofurantoin. Her family doctor has just diagnosed a urinary tract infection her third in the past 6 months. MK has discussed these recurrent episodes with her family doctor, who has offered prophylactic antibiotics, but MK is not keen on using daily antibiotics. She would like to discuss preventative treatments with you. What would your recommendations be and why?

5 Introduction to UTIs Urinary tract infections (UTIs) are microbial infections that occur anywhere along the urinary tract urethra, bladder, ureters or kidneys (Mazzulli, 2012). The female urethra is particularly prone to bacterial infection via migration from the anus or vagina (Head, 2008) and subsequent ascension of bacteria typically results in cystitis (Jepson et al., 2013). Presents with bacteruria (typically > 100,000 cfu/ml) and symptoms such as urinary frequency, urgency, pain/burning on urination, foul smelling/cloudy urine and other features of dysuria (Mazzulli, 2012; Jepson et al., 2013). As many as 50% of women report having one UTI by age 30, and up to 25% of women report recurrence within 6 months of their first UTI (Mazzulli, 2012). Etiology & Pathogenesis of UTIs Associated with altered vaginal and colonic flora (Head, 2008) % due to E. coli, 5-15% due to gram positive S. saprophyticus, remaining cases due to enteric gram negative species like Klebsiella and Proteus species (Mazzulli, 2012). Both E. coli and Proteus attach to uroepithelial cells by proteinaceous appendages called fimbriae (Head, 2008). E. coli adhere via type 1 pili long, hairy-surface organelles with a mannose binding FimH, a protein that acts as an adhesive. Adhered bacteria can invade bladder cells and form biofilms (Wellens et al., 2008)

6 Risk Factors for UTIs More frequent or intense sexual intercourse Spermicide use Tampon use New sexual partner in the last year or multiple partners Age at first UTI 15 years Maternal history of UTIs Diabetes Pregnancy History of UTIs Heavy use of antibiotics alteration of natural flora Dysfunctional voiding patterns in which there is increased tone of the external sphincter during micturition (Nickel, 2005; Head et al., 2008; Epp et al., 2010; Kodner & Thomas Gupton, 2010) Recurrent UTIs (rutis) Recurrent UTIs are defined as 2 infections in 6 months, or 3 or more infections in 1 year (Kranjcec et al., 2013) 20-30% of women will develop recurrent UTIs (Grin et al., 2013) Currently, long-term prophylactic or post-coital antibiotics are employed to reduce recurrence (Kranjcec et al., 2013). Concerns regarding efficacy, cost, side effects and potential antibiotic resistance and destruction of normal flora have prompted advocacy of alternative prophylactics such as cranberry, probiotics and d-mannose (Amdaker et al., 2011; Kranjcec et al., 2013).

7 Dietary Recommendations for UTIs Drink more water - maintains urinary flow and flushes bacteria (Head, 2008). Drink fresh fruit juices, especially berry juices - reduces recurrence of UTIs (Kontiokari et al., 2003). Reduce coffee, diet soda and caffeine intake - reduces risk of urgency and progression of UTI symptoms (Maserejian et al., 2013). Reduce alcohol intake - frequent use ( 1-3 times/week) is associated with UTIs resistant to ampicillin and cephalosporin antibiotics (Head, 2008). Consume fermented milk products containing probiotics - reduces recurrence of UTIs (Kontiokari et al., 2003). Avoid simple sugars and refined carbohydrates suppress neutrophil response (Sanchez et al., 1973) & can propagate bacterial growth. Lifestyle Recommendations for UTIs Maintain appropriate toilet hygiene wipe from front to back to avoid contaminating the urethra with feces (Nickel, 2005). Avoid use of diaphragm/spermicide contraception (Epp et al., 2010). Avoid/reduce use of tampons (Nickel, 2005). The American College of Obstetricians and Gynecologists District II NYS recommends urinating after sexual intercourse to prevent recurrent cystitis (Ballester et al., 2013). Few controlled studies support this practice, but anecdotal evidence suggests benefit (Kodner et al., 2010).

8 NHP Recommendations for UTIs We will review the possible role of the following NHPs in the management of UTIs: Cranberry Extract Probiotics D-mannose Powder Cranberry Extract Introduction American cranberry (Vaccinum macrocarpon) was historically used by North American Indians to treat UTIs (Hisano et al., 2012). The majority of human studies have focused on cranberry juice for prevention of UTIs, with initial findings suggesting benefit (Jepson et al., 2013). However, recent Cochrane Review (Jepson et al., 2013) suggests the benefit is minimal at best with poor adherence to juice intake. More recent data indicates that specific active constituents, proanthocyanidins (PACs), are responsible for the benefits of cranberry, suggesting standardized extracts may be more effective than juice consumption and future research should focus here (Jepson et al., 2013).

9 Cranberry Extract Mechanism of Action Prevents adhesion of type 1 and p-fimbriae strains (particularly E. coli) to the uroepithelium (Hisano et al., 2012) Prevents biofilm formation (Davidson et al., 2013). May increase nitric oxide production antimicrobial (Vasileiou et al., 2013). Anti-inflammatory effects symptom relief (Vasileiou et al., 2013). Cranberry Extract Evidence RCT to compare the effectiveness of cranberry extract with low-dose trimethoprim (TMP) in the prevention of rutis in older women ( 45 yoa) (McMurdo et al., 2009). 173 women with two or more antibiotic-treated UTIs in the previous 12 months were randomized to receive either 500 mg of cranberry extract (PAC content not specified) or 100 mg TMP for 6 months. 39/137 participants had an antibiotic-treated UTI (25 in cranberry group; 14 in TMP group). Time to first recurrent UTI: 84.5 days in cranberry group; 91 days in TMP group (not statistically significant). Authors concluded: TMP had very limited advantage over cranberry, with more adverse effects. Cranberry may present a natural option which does not carry the risk of antimicrobial resistance or super-infection with C. difficile or fungi.

10 Cranberry Extract Evidence cont d A randomized, double-blind non-inferiority trial in premenopausal women with rutis to test 12-month prophylaxis of trimethoprim-sulfamethoxazole (TMP- SMX) (480 mg/d) or cranberry capsules (500 mg bid, 9.1mg/g PAC) (Beerepoot et al., 2011). After 12 months the mean number of patients with at least 1 symptomatic UTI was higher in the cranberry group than in the TMP-SMX group (4.0 vs. 1.8; p=0.2). Median time to first symptomatic UTI was 4 months for cranberry and 8 months for TMP-SMX group. After 1 month, TMP-SMX, trimethoprim, amoxicillin and ciprofloxacin resistance rates were significantly increased in the TMP-SMX group, but not the cranberry group. The authors concluded that TMP-SMX was more effective than cranberry to prevent rutis, but at the expense of emerging antibiotic resistance. Cranberry Extract Evidence cont d A randomized, double blind, controlled, dose dependent clinical trial to evaluate the efficacy of a proanthocyanidin standardized whole cranberry (Vaccinium macrocarpon) powder (PS-WCP, 1.5% PAC) on infections of the urinary tract (Sengupta et al., 2011). 60 female participants with a history of rutis, and currently culture positive with mild symptoms of UTI, were randomly selected to participate and assigned to one of three groups: 1. Untreated control group (n=16) 2. Cranberry low dose (250 mg encapsulated PS-WCP bid) (n=21) 3. Cranberry high dose (500 mg encapsulated PS-WCP bid)(n=23)

11 Cranberry Extract Evidence cont d Sengupta et al., 2011 cont d 18/44 subjects in treatment groups had complete relief & remission from urological symptoms. Compared to baseline, subjects in both treatment groups reported significant improvement of symptoms at 10 days; no improvement in untreated group. Both treatment groups exhibited significant reduction of E. coli load after 10 days of treatment. At study end (90 days), E.coli in urine was reduced 65% (p<0.0001) in high dose group, 35% (p=0.0151) in low dose group; no change in untreated subjects (p=0.7234). Authors concluded this cranberry product can be suggested as an alternative/adjunct measure to conventional antibiotic therapy for recurrent urinary tract infections in women. However, in a 2012 Cochrane review, they concluded that Evidence from clinical trials does not support the use of cranberry products (juice, powder or tablets) for the prevention of UTIs. Cranberry Extract Dosage Recommended doses of dried, concentrated juice extract range from 600 to > 1200 mg/d divided into 2-3 doses (Hisano et al., 2012) mg/d extract (1.5% PAC) have been used (McMurdo et al., 2008; Beerepoot et al., 2011) PAC standardized extracts delivering 72 mg PAC/d (36 mg morning & evening) may offer protection against bacterial adhesion and virulence in the urinary tract (Howell et al., 2010). Adverse Effects Extracts generally well tolerated; no serious adverse events(mcmurdo et al., 2009; Beerepoot et al., 2011; Sengupta et al., 2011). Gastrointestinal upset (nausea, vomiting, diarrhea, constipation), mild rash/urticaria, vaginal complaints (not specified) are possible (McMurdo et al., 2009; Beerepoot et al., 2011).

12 Cranberry Extract Drug Interactions (Hisano et al., 2012) The effect of purified PAC on drug metabolism is unknown. Flavonoids in cranberry can affect cytochrome P450 enzymes and are aromatase inhibitors. Cranberry juice confers a significant reduction in the activity of nifedipine oxidase(cyp3a4) oral clearance and serum concentration. Cranberry juice (only in large quantities) cause changes in the international normalized ratio (INR) and prothrombin time (PT) in patients using warfarin (Rindone 2006). Cautions and Contraindications Known allergy to Vaccinum species or plants of the Ericaceae family. May cause thrombocytopenia and nephrolithiasis; effect not fully established (Hisano et al., 2012). Probiotics Introduction Live microorganisms which when administered in adequate amounts confer a health benefit on the host (FAO/WHO, 2002). They have GRAS (generally regarded as safe) status (Amdekar et al., 2011) Lactobacillus is an important part of the normal flora, which is commonly found in the mouth, gastrointestinal tract and female genitourinary tract (Amdekar et al., 2011). Reduction in the number of Lactobacillus increases risk of UTI (Amdekar et al., 2011).

13 Probiotics Mechanism of Action (Cadieux et al., 2009; Amdekar et al., 2011; Chapman et al., 2013) Maintains acidic ph via production of lactic acid & hydrogen peroxide. Antimicrobial activity. Prevents colonization by pathogen. Stimulates host immunity. Degrades toxins created by pathogen. Probiotics Evidence Randomized, placebo-controlled phase 2 trial of intravaginal probiotic Lactobacillus crispatus for prevention of ruti (Stapleton et al., 2011) 100 women (18-40 yoa) with history of ruti received antimicrobials for acute UTI, then randomized to receive vaginal probiotic (10 8 CFU/mL) or placebo daily for 5 days, then once weekly for 10 weeks. ruti occurred in 7/48 (15%) of women receiving probiotic compared with 13/48 (27%) of placebo. High level vaginal colonization with L. crispatus throughout follow-up was associated with significant reduction in ruti only for probiotic (relative risk for probiotic 0.07; relative risk for placebo, 1.1; P< 0.01) L. crispatus intravaginal probiotic after treatment for cystitis is associated with reduction in ruti.

14 Probiotics Evidence cont d Randomized, double-blind, noninferiority trial of oral capsules of Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 probiotic vs. trimethoprim-sulfamethoxazole (TMP-SMX) for prevention of ruti in postmenopausal women (Beerepoot et al., 2012) 252 women randomized to 12 months of either 480 mg qd TMP-SMX or probiotic (10 9 CFU/cap) bid. Primary end points were the mean number of symptomatic UTIs, proportion of participants with at least 1 UTI during 12 months, time to first UTI, and development of antibiotic resistance by E. coli. Probiotics Evidence cont d (Beerepoot et al., 2013 cont d) TMP-SMX Group Probiotic Group Conclusions Mean # Symptomatic UTIs 1 year before randomization After prophylaxis Proportion of subjects w/ 1 UTI in 12 months % 79.1% Median time to 1 st UTI 6 months 3 months The betweentreatment difference of 0.4 UTIs per year (95% CI, 0.4 to 1.5) was outside the noninferiority margin. However, unlike TMP- SMX, lactobacilli do not increase antibiotic resistance. Antibiotic Resistance Increased from 20% - 40% to 80% - 95%. No resistance

15 Probiotics Evidence cont d Systematic review and meta-analysis of current RCTs to determine the efficacy of probiotic Lactobacillus species in preventing ruti (Grin et al., 2013). Data from 127 patients in two studies of intravaginal application were included. Only 1 study looked at oral dosage and used an ineffectual strain, so was excluded. A statistically significant decrease in ruti was found in patients given Lactobacillus, denoted by pooled risk ratio of 0.51 (95% CI , p=0.05). Authors concluded probiotic strains of Lactobacillus are safe and effective for prevention of ruti in adult women. Probiotics Dosage Intravaginal: L.crispatus 10 8 CFU/mL for 5 days, followed by once weekly for 10 weeks (Stapleton et al., 2011). Oral: L. rhamnosus GR-1 and L. reuteri RC-14 shown to restore vaginal flora in 1 month using 10 8 CFU qd and in 14 days using 10 9 CFU bid, respectively (Reid et al., 2001a, 2001b).

16 Probiotics Adverse Effects Intravaginal: Application of L. crispatus has been associated with moderate vaginal discharge and genital irritation in both treatment and placebo groups, suggesting the base medium for the suppository may be the cause (Stapleton et al., 2011). Oral: No serious adverse effect with oral administration of L. rhamnosus GR-1 and L. reuteri RC-14 (Beerepoot et al., 2013). May cause nausea, vomiting, diarrhea or constipation. Flatulence is common with oral probiotic use, but subsides with continued therapy. Probiotics Drug Interactions Take 2-3 hours away from antibiotics in order to preserve activity of antibiotics and probiotics. Cautions and Contraindications Immunocompromised, chronically ill, hospitalized patients with gastrointestinal disorders and indwelling catheters may be predisposed to probiotic sepsis (D Souza et al. 2002; Verna et al. 2010).

17 D-Mannose Powder Introduction D-mannose is a simple sugar important in human metabolism, especially in the glycosylation of certain proteins. Mechanism of Action D-mannose binds to the type 1 pili of enteric bacteria blocking their adhesion to uroepithelial cells (Wellens et al., 2008; Kranjcec et al., Inhibits epithelial invasion by bacteria and subsequent biofilm formation (Wellens et al., 2008). D-Mannose Powder Evidence 6 month, prospective RCT to determine the effect of regular intake of D-mannose powder (2 g/d) on reducing the rate of ruti compared to standard Nitrofurantoin (50 mg/d) prophylaxis and no intervention (n=308) (Kranjcec et al., 2013). Patients in D-mannose and Nitrofurantoin groups had a significantly lower risk of ruti compared to no prophylaxis group (RR and 0.335, P<0.0001). The difference between D-mannose and Nitrofurantoin groups was not significant. D-mannose powder was equally efficient in UTI prevention as standard Nitrofurantoin prophylaxis.

18 D-Mannose Powder Dosage 2 grams per day dissolved in 200 ml of water (Kranjcec et al., 2013). Adverse Effects Diarrhea reported by 8 of 103 participants and did not require discontinuation (Kranjcec et al., 2013) Drug Interactions, Cautions and Contraindications None known. Case Study Review Case Highlights Patient: MK, 36-year-old female CCs: active UTI, 3 rd in past 6 months Social History: Does not want to use prophylactic antibiotics Current Medications: Current Rx for Nitrofurantoin

19 Case Study Conclusions The guidelines of the European Association of Urology suggest that, because of possible adverse events and concern about selecting resistant pathogens, antimicrobial prophylaxis should be considered only after counseling, behavioural modification and non-antimicrobial measures have been attempted (Davidson et al., 2013). Based on these guidelines and MK s desire to avoid antibiotic prophylaxis, you can suggest the following dietary and lifestyle modifications, and NHP recommendations: Diet Case Study Conclusions Drink plenty of water to maintain urinary flow and flush bacteria. Try cranberry juice/berry juice to control symptoms via anti-inflammatory mechanisms. Reduce coffee, diet soda, caffeine and alcohol to minimize progression of UTI symptoms. Avoid simple sugars and refined carbohydrates. Consume fermented milk products, with probiotics. Lifestyle Practice post-coital urinary voiding to flush bacteria that may enter the urethra. Avoid spermicides.

20 Case Study Conclusions NHP Recommendations Cranberry extract: mg/d (ideally with standardized PAC content: ~ 72 mg/d). Probiotics: Due to her nitrofurantoin prescription, MK is at risk of altered microflora in the gastrointestinal and genitourinary tracts. MK s rutis reflect currently altered microflora. A multi-strain probiotic capsule containing at least 5 billion CFUs 3-4 times per day to replenish gastrointestinal flora. Orally L. rhamnosus GR-1 and L. reuteri RC-14, minimum of 1 billion CFU/d for 1 month to restore vaginal microflora. For greater effect in reducing rutis, intravaginal probiotics containing L. crispatus at 10 8 CFUs/mL or other vaginal strains (e.g. L. gasseri, L. rhamnosus) may be more effective. D-mannose powder: 2 g/d dissolved in 200 ml of water. Practical Considerations for the Pharmacist Offer advice and recommendations to patients regarding the use of natural health products. Advise the patient to: Inform their health care provider and pharmacist which natural health products they are taking. Maintain a list of natural health products that they are using and take it with them to their medical appointments. If they are contemplating starting to take natural health products, consult with their health care provider and pharmacist to ensure there are no risks of NHP-medication interaction.

21 Conclusions Women face health concerns throughout their lifetime that are unique to their physiology, hormones and genetic composition. Given that women tend to make healthier lifestyle choices, they are also more apt to seek alternative health advice, often turning to their pharmacists as a first line of information. Although many NHPs do promote and enhance good health, they are only safe when used under the right conditions. As a first line of information for the majority of Canadians, a pharmacist can advise patients if an NHP is right for them on an individualized basis, discussing benefits and risks.

RECURRENT URINARY TRACT INFECTIONS: WHAT AN INTERNIST

RECURRENT URINARY TRACT INFECTIONS: WHAT AN INTERNIST RECURRENT URINARY TRACT INFECTIONS: WHAT AN INTERNIST MUST KNOW PROF. MD. ENAMUL KARIM Professor of Medicine Green Life Medical College INTRODUCTION Urinary tract infection (UTI) is one of the commonest

More information

The nutrition assessment of an individual with a UTI or wanting to prevent a UTI may include the following parameters using NCP terminology:

The nutrition assessment of an individual with a UTI or wanting to prevent a UTI may include the following parameters using NCP terminology: Last Updated: 2017-02-28 Description and Key Nutrition Issues Description Urinary tract infections (UTIs) involve the upper and/or lower urinary tract, affecting the kidneys, bladder, urethra or prostate.

More information

UTI are the most common genitourinary disease of childhood. The prevalence of UTI at all ages is girls and 1% of boys.

UTI are the most common genitourinary disease of childhood. The prevalence of UTI at all ages is girls and 1% of boys. UTI are the most common genitourinary disease of childhood. The prevalence of UTI at all ages is girls and 1% of boys. 1-3% of Below 1 yr. male: female ratio is 4:1 especially among uncircumcised males,

More information

TMP/SMZ DS Ciprofloxacin Norfloxacin Ofloxacin Cefadroxil * 30 Amoxicilin 86* 19 25

TMP/SMZ DS Ciprofloxacin Norfloxacin Ofloxacin Cefadroxil * 30 Amoxicilin 86* 19 25 Evidence-Based Evaluation and Treatment of UTI UTI Prevalence Leslee L. Subak, MD Associate Professor Obstetrics, Gynecology & RS Epidemiology & Biostatistics University of California, San Francisco 50%

More information

URINARY TRACT INFECTIONS

URINARY TRACT INFECTIONS URINARY TRACT INFECTIONS Learning Objectives Identify signs and symptoms that may indicate presence of UTI (both complicated and uncomplicated) List common causative organisms and risk factors for UTIs

More information

Definition/Epidemiology Approach to premenopausal and postmenopausal women A couple tricky cases DISCLOSURES. No financial relationships to disclose.

Definition/Epidemiology Approach to premenopausal and postmenopausal women A couple tricky cases DISCLOSURES. No financial relationships to disclose. DISCLOSURES RECURRENT URINARY TRACT INFECTIONS No financial relationships to disclose. Anna C. Kirby, MD, MAS Acting Assistant Professor University of Washington Division of Urogynecology Department of

More information

Running Head: EFFICACY OF CRANBERRY PRODUCTS 1. Efficacy of Cranberry Products: An Alternative UTI Treatment. Christopher Mann.

Running Head: EFFICACY OF CRANBERRY PRODUCTS 1. Efficacy of Cranberry Products: An Alternative UTI Treatment. Christopher Mann. Running Head: EFFICACY OF CRANBERRY PRODUCTS 1 Efficacy of Cranberry Products: An Alternative UTI Treatment Christopher Mann The Sage Colleges EFFICACY OF CRANBERRY PRODUCTS 2 One of the most common bacterial

More information

6/4/2018. Conflicts Disclosure. Objectives. Introduction. Classifications of UTI. Host Defenses. Management of Recurrent Urinary Tract Infections

6/4/2018. Conflicts Disclosure. Objectives. Introduction. Classifications of UTI. Host Defenses. Management of Recurrent Urinary Tract Infections Conflicts Disclosure Presenter has no conflicts of interest to disclose Management of Recurrent Urinary Tract Infections COLIN M. GOUDELOCKE, M.D. JUNE 14, 2018 Objectives Attendees will review the identification

More information

Urinary Tract Infections

Urinary Tract Infections Urinary Tract Infections Michelle Eslami, M.D., FACP Professor of Medicine Division of Geriatrics David Geffen SOM at UCLA Urinary Tract Infection (UTI) One of most common infections in outpatient and

More information

Natural and Holistic Medicine Approach in Evaluation and Treatment of Vaginal and Urinary Tract Health

Natural and Holistic Medicine Approach in Evaluation and Treatment of Vaginal and Urinary Tract Health Natural and Holistic Medicine Approach in Evaluation and Treatment of Vaginal and Urinary Tract Health By Dr. Michael John Badanek, BS, DC, CNS, CTTP, DACBN, DCBCN, MSGR./CHEV While the gut has an estimated

More information

Treatment Regimens for Bacterial Urinary Tract Infections. Characteristic Pathogen. E. coli, S.saprophyticus P.mirabilis, K.

Treatment Regimens for Bacterial Urinary Tract Infections. Characteristic Pathogen. E. coli, S.saprophyticus P.mirabilis, K. HEALTHSPAN URINARY TRACT INFECTIONS (ADULT FEMALE) Methodology: Evidence-Based Issue Date: 1-98 Champion: Internal Medicine Most Recent Review: 4-10, 4-12, 4-14 Key Stakeholders: IM, Urology, Next Review:

More information

Urinary Tract Infections

Urinary Tract Infections Urinary Tract Infections Introduction A urinary tract infection, or UTI, is an infection of the urinary tract. Infections are caused by microbes, including bacteria, fungi and viruses. Microbes are organisms

More information

Urinary Tract Infections: From Pyelonephritis to Asymptomatic Bacteriuria. Leslee L. Subak, MD

Urinary Tract Infections: From Pyelonephritis to Asymptomatic Bacteriuria. Leslee L. Subak, MD Urinary Tract Infections: From Pyelonephritis to Asymptomatic Bacteriuria Leslee L. Subak, MD Professor Obstetrics, Gynecology & RS Epidemiology & Urology University of California, San Francisco UTI Prevalence

More information

Management of UTI. Disclosures. Uncomplicated UTI UTI CLASSIFICATION. Where do UTI bugs come from? Food Sex

Management of UTI. Disclosures. Uncomplicated UTI UTI CLASSIFICATION. Where do UTI bugs come from? Food Sex Management of UTI Thomas M. Hooton, M.D. University of Miami Miami, Florida Disclosures Fimbrion a biotech company with mission to develop novel approaches to treat and prevent UTI Co-founder and shareholder

More information

Investigators Meeting

Investigators Meeting Outcomes of Urinary Tract Infection Management by Pharmacists (R x OUTMAP) Investigators Meeting June 11, 2017 Overview 1. Introductions and Opening Remarks 2. Epidemiology and Definitions 3. UTI Assessment

More information

Cranberries and Urinary Tract Infections

Cranberries and Urinary Tract Infections Cranberries and Urinary Tract Infections Urinary tract infections (UTIs) are a widespread and serious problem infecting millions of people each year. In the United States, 34% of adults over 20 self-reported

More information

Pediatric urinary tract infection. Dr. Nariman Fahmi Pediatrics/2013

Pediatric urinary tract infection. Dr. Nariman Fahmi Pediatrics/2013 Pediatric urinary tract infection Dr. Nariman Fahmi Pediatrics/2013 objectives EPIDEMIOLOGY CAUSATIVE PATHOGENS PATHOGENESIS CATEGORIES OF URINARY TRACT INFECTIONS AND CLINICAL MANIFESTATIONS IN pediatrics

More information

KAISER PERMANENTE OHIO URINARY TRACT INFECTIONS (ADULT FEMALE)

KAISER PERMANENTE OHIO URINARY TRACT INFECTIONS (ADULT FEMALE) KAISER PERMANENTE OHIO URINARY TRACT INFECTIONS (ADULT FEMALE) Methodology: Evidence-Based Issue Date: 1-98 Champion: Internal Medicine Most Recent Review: 4-10, 4-12 Key Stakeholders: IM, Urology, Next

More information

Anatomy kidney ureters bladder urethra upper lower

Anatomy kidney ureters bladder urethra upper lower Urinary tract Anatomy The urinary tract consists of the kidney, ureters, bladder, and urethra. Urinary tract infections can be either: upper or lower based primarily on the anatomic location of the infection.

More information

URINARY TRACT INFECTIONS 3 rd Y Med Students. Prof. Dr. Asem Shehabi Faculty of Medicine, University of Jordan

URINARY TRACT INFECTIONS 3 rd Y Med Students. Prof. Dr. Asem Shehabi Faculty of Medicine, University of Jordan URINARY TRACT INFECTIONS 3 rd Y Med Students Prof. Dr. Asem Shehabi Faculty of Medicine, University of Jordan Urinary Tract Infections-1 Normal urine is sterile.. It contains fluids, salts, and waste products,

More information

Patient Group Direction for the Supply of Nitrofurantoin MR 100mg capsules

Patient Group Direction for the Supply of Nitrofurantoin MR 100mg capsules October 2016 Patient Group Direction for the Supply of Nitrofurantoin MR 100mg capsules This Patient Group Direction (PGD) is a specific written instruction for the supply and/or administration of nitrofurantoin

More information

Lecture 1: Genito-urinary system. ISK

Lecture 1: Genito-urinary system. ISK Urinary Tract Infections Lecture 1: Genito-urinary system. ISK 07 08 2009. Getting Clear on the Terminology UTI Cystitis Urosepsis Asymptomatic Bacteriuria Asymptomatic UTI Pyuria Symptomatic UTI Pylonephritis

More information

UTI IN ELDERLY. Zeinab Naderpour

UTI IN ELDERLY. Zeinab Naderpour UTI IN ELDERLY Zeinab Naderpour Urinary tract infection (UTI) is the most frequent bacterial infection in elderly populations. While urinary infection in the elderly person is usually asymptomatic, symptomatic

More information

Vaginitis Lifestyle changes that may be helpful:

Vaginitis Lifestyle changes that may be helpful: Vaginitis Vaginitis, inflammation of the vagina, is responsible for an estimated 10% of all visits by women to their healthcare practitioners. The three general causes of vaginitis are hormonal imbalance,

More information

It is an infection affecting any of the following parts like kidney,ureter,bladder or urethra

It is an infection affecting any of the following parts like kidney,ureter,bladder or urethra UTI Dr jayaprakash.k.p,asst prof,ich,govt.medical college,kottayam What is UTI? It is an infection affecting any of the following parts like kidney,ureter,bladder or urethra What is prevalence of UTI?

More information

Dietary supplements to prevent recurrent UTI: The evidence

Dietary supplements to prevent recurrent UTI: The evidence Dietary supplements to prevent recurrent UTI: The evidence Kris Cvach Fellow Female Pelvic Medicine and Reconstructive Surgery UBC 31st March 2010 Outline Epidemiology of UTI Pathophysiology of UTI Supplements

More information

Urinary tract infection. Mohamed Ahmed Fouad Lecturer of pediatrics Jazan faculty of medicine

Urinary tract infection. Mohamed Ahmed Fouad Lecturer of pediatrics Jazan faculty of medicine Urinary tract infection Mohamed Ahmed Fouad Lecturer of pediatrics Jazan faculty of medicine Objectives To differentiate between types of urinary tract infections To recognize the epidemiology of UTI in

More information

Preventing Urinary Tract Infections. James Meschino DC, MS, ND

Preventing Urinary Tract Infections. James Meschino DC, MS, ND Preventing Urinary Tract Infections James Meschino DC, MS, ND After the common cold, the second most common health condition that accounts for visits to doctors offices are urinary tract infections. In

More information

Urinary tract infections, renal malformations and scarring

Urinary tract infections, renal malformations and scarring Urinary tract infections, renal malformations and scarring Yaacov Frishberg, MD Division of Pediatric Nephrology Shaare Zedek Medical Center Jerusalem, ISRAEL UTI - definitions UTI = growth of bacteria

More information

PROBIOTICS. The Ultimate Flora Difference

PROBIOTICS. The Ultimate Flora Difference In the Refrigerator Section! PROBIOTICS High-Potency Daily, Critical Care and Targeted Probiotic Formulas to Improve Regularity, Strengthen Natural Defenses and Promote Overall Digestion * The ReNew Life

More information

11/15/2010. Asymptomatic Bacteriuria UTI. Symptomatic UTI. Asymptomatic UTI. Cystitis. Pylonephritis. Pyuria. Urosepsis

11/15/2010. Asymptomatic Bacteriuria UTI. Symptomatic UTI. Asymptomatic UTI. Cystitis. Pylonephritis. Pyuria. Urosepsis Urinary Tract Infections Renal vein Inferior vena cava Urinary bladder Urethra Renal artery Kidney Aorta Ureter Lecture 1: Genito-urinary system. 06 08 2010. (a) Sherwood Fig. 12-6a, p.530 An introduction

More information

UTI: A practical approach. Justin Seroy, DO Infectious Disease Attending BUMC-P

UTI: A practical approach. Justin Seroy, DO Infectious Disease Attending BUMC-P UTI: A practical approach Justin Seroy, DO Infectious Disease Attending BUMC-P UTI Pathophysiology Uropathogens colonize urethra, vagina or perineal area -> Enter lower urinary tract ->bladder ->kidney

More information

Recurrent UTI in Adult Women: Contemporary Management & Future Prospects. Chris Harding

Recurrent UTI in Adult Women: Contemporary Management & Future Prospects. Chris Harding Recurrent UTI in Adult Women: Contemporary Management & Future Prospects Chris Harding What is the definition of recurrent UTI (ruti)? No universally accepted definition Most commonly used is 2 in 6 months

More information

Recurrent urinary tract infections

Recurrent urinary tract infections Recurrent urinary tract infections This booklet is designed to help women understand more about recurrent urinary tract infections and the choices available. Please keep it and take it with you to your

More information

UTI. Monica Tegeler, MD

UTI. Monica Tegeler, MD 4 UTI Monica Tegeler, MD 2 Diagnosis Stone criteria >100,000 colonies of bacteria growing in urine with no more than 2 species of microorganisms Dysuria OR Fever AND 1 of following: Frequency Urgency Suprapubic

More information

P. Brandstrom has documented that he has no relevant financial relationships to disclose or conflict of interest to resolve.

P. Brandstrom has documented that he has no relevant financial relationships to disclose or conflict of interest to resolve. P. Brandstrom has documented that he has no relevant financial relationships to disclose or conflict of interest to resolve. Prophylaxis or not? Per Brandström Queen Silvia Children s Hospital Gothenburg

More information

Patient Group Direction for the Supply of Trimethoprim 200mg tablets

Patient Group Direction for the Supply of Trimethoprim 200mg tablets October 2016 Patient Group Direction for the Supply of Trimethoprim 200mg tablets This Patient Group Direction (PGD) is a specific written instruction for the supply of trimethoprim 200mg tablets to groups

More information

Probiotics for Primary Prevention of Clostridium difficile Infection

Probiotics for Primary Prevention of Clostridium difficile Infection Probiotics for Primary Prevention of Clostridium difficile Infection Objectives Review risk factors for Clostridium difficile infection (CDI) Describe guideline recommendations for CDI prevention Discuss

More information

Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana, Anis Karuniawati, Yulia Rosa, Budiman Bela

Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana, Anis Karuniawati, Yulia Rosa, Budiman Bela Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana, Anis Karuniawati, Yulia Rosa, Budiman Bela Microbiology Department Medical Faculty, University of Indonesia Urinary Tract Infection

More information

Recurrent Cystitis in Women Urology Patient Information Leaflet

Recurrent Cystitis in Women Urology Patient Information Leaflet Recurrent Cystitis in Women Urology Patient Information Leaflet Page 1 What is cystitis? Cystitis is an inflammation of the bladder lining. It is common for the water outlet pipe (the urethra) to be affected

More information

Update in diagnosis and management of UTIs

Update in diagnosis and management of UTIs Update in diagnosis and management of UTIs I have no disclosures Brian S. Schwartz, MD UCSF, Division of Infectious Diseases Lecture outline Challenges in cystitis Complicated UTI/pyelonephritis Asymptomatic

More information

Mechanism of action of cranberry in preventing urinary tract infections

Mechanism of action of cranberry in preventing urinary tract infections Mechanism of action of cranberry in preventing urinary tract infections Further to a description of the pathophysiology of urinary tract infections (UTIs) of the uroepithelial cells by Escherichia coli

More information

OCTOBER 2017 DRUG ANTIBIOTICS. Presence of bacteria in the urine with no symptoms or clinical signs.

OCTOBER 2017 DRUG ANTIBIOTICS. Presence of bacteria in the urine with no symptoms or clinical signs. OCTOBER 2017 DRUG ANTIBIOTICS This optimal usage guide is mainly intended for primary care health professionnals. It is provided for information purposes only and should not replace the clinician s judgement.

More information

The McMaster at night Pediatric Curriculum

The McMaster at night Pediatric Curriculum The McMaster at night Pediatric Curriculum Robinson, J, et al. and the Canadian Pediatric Society. Urinary tract infection in infants and children: Diagnosis and management. Pediatr Child Health 2014;

More information

EMPIRICAL TREATMENT OF SELECT INFECTIONS ADULT GUIDELINES. Refer to VIHA Algorithm for the empiric treatment of Urinary Tract Infection

EMPIRICAL TREATMENT OF SELECT INFECTIONS ADULT GUIDELINES. Refer to VIHA Algorithm for the empiric treatment of Urinary Tract Infection URINARY TRACT Refer to VIHA Algorithm for the empiric treatment of Urinary Tract Infection and Asymptomatic Bacteriuria on the VIHA Intranet: https://intranet.viha.ca/departments/pharmacy/clinical_pharmacy/pages/infec

More information

Understanding probiotics and health

Understanding probiotics and health Understanding probiotics and health Gemma Laws MSc Student Microbiology and Immunology Department The gut microbiota The name given to the total microbial population living in our intestine Bacteria, fungi,

More information

Summary of Product Characteristics

Summary of Product Characteristics Brand Name: OXALO [Pre Probiotic] Capsules Therapeutic Category: Prevention of Stone Formation Urinary tract stone disease has been a part of the human condition for millennia; in fact, bladder and kidney

More information

PROBIOTICS: WHO S WHO AND WHAT S WHAT IN THE GUT PROBIOTICS: WHAT ARE THEY, AND HOW DO THEY WORK? Karen Jensen, (Retired ND)

PROBIOTICS: WHO S WHO AND WHAT S WHAT IN THE GUT PROBIOTICS: WHAT ARE THEY, AND HOW DO THEY WORK? Karen Jensen, (Retired ND) PROBIOTICS: WHO S WHO AND WHAT S WHAT IN THE GUT Karen Jensen, (Retired ND) Today many people are aware of the benefits of maintaining a healthy gut. As a result, probiotic use is becoming ever more popular.

More information

Bacterial urinary tract infections

Bacterial urinary tract infections Vet Times The website for the veterinary profession https://www.vettimes.co.uk Bacterial urinary tract infections Author : CATHERINE F LE BARS Categories : Vets Date : February 11, 2008 CATHERINE F LE

More information

ULTIMATE FLORA PROBIOTICS

ULTIMATE FLORA PROBIOTICS ULTIMATE FLORA PROBIOTICS In the Refrigerator Section! High-Potency Daily, Critical Care and Targeted Probiotic Formulas to Improve Regularity, Strengthen Natural Defenses and Promote Overall Digestion*

More information

Bacterial Infections of the Urinary System *

Bacterial Infections of the Urinary System * OpenStax-CNX module: m64804 1 Bacterial Infections of the Urinary System * Douglas Risser This work is produced by OpenStax-CNX and licensed under the Creative Commons Attribution License 4.0 1 Learning

More information

Urinary Tract Infections in Hospitalized Patients

Urinary Tract Infections in Hospitalized Patients Urinary Tract Infections in Hospitalized Patients Puerto Rico Chapter Annual Meeting Daniel C. DeSimone, MD March 9, 2019 2017 MFMER slide-1 Disclosures for speaker: Date of presentation: 3/9/2019 No relevant

More information

CLAIMS CERTIFICATIONS

CLAIMS CERTIFICATIONS CRANBERRY CLAIMS Reduce the risk of urinary tract infection Exhibit bacterial anti adhesion activity Reduces the incidence of E. coli infections Reduces the incidence of recurrent urinary bladder infections

More information

Guidelines for Recurrent Urinary Tract Infections in Adults: Antibiotic Prophylaxis

Guidelines for Recurrent Urinary Tract Infections in Adults: Antibiotic Prophylaxis Guidelines for Recurrent Urinary Tract Infections in Adults: Antibiotic Prophylaxis Definition of recurrent lower urinary tract infection: The symptoms of a lower urinary tract infection include: frequency,

More information

Pathogenesis of Infectious Diseases. CLS 212: Medical Microbiology

Pathogenesis of Infectious Diseases. CLS 212: Medical Microbiology Pathogenesis of Infectious Diseases CLS 212: Medical Microbiology Definitions Path- means disease. Pathogenesis The steps or mechanisms involved in the development of a disease. Infection The presence

More information

SCIENTIFIC OPINION. EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) 2,3. European Food Safety Authority (EFSA), Parma, Italy

SCIENTIFIC OPINION. EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) 2,3. European Food Safety Authority (EFSA), Parma, Italy SCIENTIFIC OPINION Scientific Opinion on the substantiation of a health claim related to CranMax and reduction of the risk of urinary tract infection by inhibiting the adhesion of certain bacteria in the

More information

Asyntomatic bacteriuria, Urinary Tract Infection

Asyntomatic bacteriuria, Urinary Tract Infection Asyntomatic bacteriuria, Urinary Tract Infection C. Infectious Diseases Society of America Guidelines for the Diagnosis and Treatment of Asyntomatic Bacteriuria in Adults (2005) Pyuria accompanying asymptomatic

More information

EAU-Guidelines for the Treatment of Uncomplicated UTI

EAU-Guidelines for the Treatment of Uncomplicated UTI EAU-Guidelines for the Treatment of Uncomplicated UTI Kurt G. Naber Technical University of Munich, Germany Sao Paulo, 26 May 2007 Gäubodenvolksfest - Straubing EAU Guidelines for the Management of Urinary

More information

Antibiotic Guidelines for URINARY TRACT/ UROLOGY infections

Antibiotic Guidelines for URINARY TRACT/ UROLOGY infections Antibiotic Guidelines f URINARY TRACT/ UROLOGY infections CLINICAL CONDITION USEFUL INFORMATION RECOMMENDATIONS ALTERNATIVE (suitable in serious penicillin allergy) Asymptomatic Bacteriuria (in the absence

More information

SHABNAM TEHRANI M.D., MPH ASSISTANT PROFESSOR OF INFECTIOUS DISEASESE &TROPICAL MEDICINE RESEARCH CENTER, SHAHID BEHESHTI UNIVERSITY OF MEDICAL

SHABNAM TEHRANI M.D., MPH ASSISTANT PROFESSOR OF INFECTIOUS DISEASESE &TROPICAL MEDICINE RESEARCH CENTER, SHAHID BEHESHTI UNIVERSITY OF MEDICAL URINARY TRACT INFECTION SHABNAM TEHRANI M.D., MPH ASSISTANT PROFESSOR OF INFECTIOUS DISEASESE &TROPICAL MEDICINE RESEARCH CENTER, SHAHID BEHESHTI UNIVERSITY OF MEDICAL SCIENCES Definition inflammatory

More information

Customary urine test is the dip stick and the mid-stream culture of voided urine. Up to 77% of cystitis cases are cultured

Customary urine test is the dip stick and the mid-stream culture of voided urine. Up to 77% of cystitis cases are cultured 9 million visits/year! Customary urine test is the dip stick and the mid-stream culture of voided urine. Up to 77% of cystitis cases are cultured Interpretation of the culture result has been controversial-

More information

Clinical Study Phase I Trial of a Lactobacillus crispatus Vaginal Suppository for Prevention of Recurrent Urinary Tract Infection in Women

Clinical Study Phase I Trial of a Lactobacillus crispatus Vaginal Suppository for Prevention of Recurrent Urinary Tract Infection in Women Infectious Diseases in Obstetrics and Gynecology Volume 2007, Article ID 35387, 8 pages doi:10.1155/2007/35387 Clinical Study Phase I Trial of a Lactobacillus crispatus Vaginal Suppository for Prevention

More information

UTIs in children ( with controversies ) By Dr. Lindokuhle Mahlase

UTIs in children ( with controversies ) By Dr. Lindokuhle Mahlase UTIs in children ( with controversies ) By Dr. Lindokuhle Mahlase Epidemiology By age 7 years, 8 % of girls and 2 % of boys will have had a UTI. Most infections occur in the first 2 years of life ; boys

More information

URINARY TRACT INFECTIONS 3 rd Y Med Students. Prof. Dr. Asem Shehabi Faculty of Medicine, University of Jordan

URINARY TRACT INFECTIONS 3 rd Y Med Students. Prof. Dr. Asem Shehabi Faculty of Medicine, University of Jordan URINARY TRACT INFECTIONS 3 rd Y Med Students Prof. Dr. Asem Shehabi Faculty of Medicine, University of Jordan Urinary Tract Infections-1 Normal urine is sterile in urinary bladder.. It contains fluids,

More information

Urinary tract infection - adults

Urinary tract infection - adults 1 of 9 12/30/2012 11:07 PM PubMed Health. A service of the National Library of Medicine, National Institutes of Health. A.D.A.M. Medical Encyclopedia. Atlanta (GA): A.D.A.M.; 2011. Urinary tract infection

More information

Urinary Tract Infections: From Simple to Complex. Adriane N Irwin, MS, PharmD, BCACP Clinical Assistant Professor Ambulatory Care October 25, 2014

Urinary Tract Infections: From Simple to Complex. Adriane N Irwin, MS, PharmD, BCACP Clinical Assistant Professor Ambulatory Care October 25, 2014 Urinary Tract Infections: From Simple to Complex Adriane N Irwin, MS, PharmD, BCACP Clinical Assistant Professor Ambulatory Care October 25, 2014 Learning Objectives Develop empiric antimicrobial treatment

More information

Urinary tract infections

Urinary tract infections بسم رلاهللا Urinary tract infections This sheet will only contain extra notes said by the dr. UTIs: - is the second most common type of infections in community(second only to RTIs) - Incidence=20-30% of

More information

15. Prevention of UTI and lifestyle modifications

15. Prevention of UTI and lifestyle modifications 15. Prevention of UTI and lifestyle modifications Key questions: Does improving poor voiding habits help prevent UTI recurrence? Does improving constipation help prevent UTI recurrence? Does increasing

More information

Brought to you by Ellura to promote urinary tract health

Brought to you by Ellura to promote urinary tract health YOUR GUIDE TO A HEALTHY URINARY TRACT Naturally INCLUDES USEFUL DIET AND LIFESTYLE TIPS Brought to you by Ellura to promote urinary tract health Always read the label. Use only as directed. If pain or

More information

ORAL HEALTH COMPLICATIONS?

ORAL HEALTH COMPLICATIONS? ORAL HEALTH COMPLICATIONS? Your pathway to a better oral health ORAL HEALTH AND PERIODONTAL (GUM) DISEASE Dental cavities are a multifactorial disease of bacterial origin that is characterized by acid

More information

Chapter 47 1/8/2018. Urinary System Disorders. Urinary Tract Infections. Treatment

Chapter 47 1/8/2018. Urinary System Disorders. Urinary Tract Infections. Treatment Chapter 47 Urinary System Disorders Urinary Tract Infections Urinary tract infections (UTIs) are common Infection in one area can involve the entire system Microbes enter through the urethra. Catheterization,

More information

Urinary Tract Infection. Clinical Background. Quality Department

Urinary Tract Infection. Clinical Background. Quality Department Quality Department Guidelines for Clinical Care Ambulatory Urinary Tract Infection Guideline Team Team Leader Steven E Gradwohl, MD General Medicine Team Members Catherine M Bettcher, MD Family Medicine

More information

Patient Group Direction (PGD)

Patient Group Direction (PGD) Patient Group Direction (PGD) Supply of Nitrofurantoin for uncomplicated Urinary Tract Infections in females aged 16 years and over (Telford and Wrekin and Shropshire Pharmacies Only) For the supply of

More information

2/11/2019. Urinary Tract Infections: Evidence Based Treatment (From the Simple to Complex) Disclosures. Objectives. No Relevant Disclosures (I wish)

2/11/2019. Urinary Tract Infections: Evidence Based Treatment (From the Simple to Complex) Disclosures. Objectives. No Relevant Disclosures (I wish) Urinary Tract Infections: Evidence Based Treatment (From the Simple to Complex) David R. Ellington, MD, FACOG Associate Professor Associate Fellowship Director Division of Urogynecology and Pelvic Reconstructive

More information

Case studies. Stephen Mark Rob Walker

Case studies. Stephen Mark Rob Walker Case studies Stephen Mark Rob Walker Case 1 31 yr old woman with 3 rd UTI. E coli Frequency and dysuria Asymptomatic after treatment Recurrent UTI Lower tract symptoms Coliforms Asymptomatic after treatment

More information

THE NATURAL WAY TO CURE AND PROTECT AGAINST YEAST INFECTIONS

THE NATURAL WAY TO CURE AND PROTECT AGAINST YEAST INFECTIONS JULY 16 TO SEPTEMBER 15 2005 THE NATURAL WAY TO CURE AND PROTECT AGAINST YEAST INFECTIONS At some point in life, nearly every woman will experience a vaginal infection. The type and frequency at which

More information

Diagnosis and Management of UTI s in Care Home Settings. To Dip or Not to Dip?

Diagnosis and Management of UTI s in Care Home Settings. To Dip or Not to Dip? Diagnosis and Management of UTI s in Care Home Settings To Dip or Not to Dip? 1 Key Summary Points: Treat the patient NOT the urine In people 65 years, asymptomatic bacteriuria is common. Treating does

More information

Dr Anna Lawrence. Mr Simon Van Rij

Dr Anna Lawrence. Mr Simon Van Rij Mr Simon Van Rij Urologist OneSixOne Urology Auckland Dr Anna Lawrence Urologist Auckland Surgical Centre Auckland 8:30-9:25 WS #94: Management of Common Urologic Problems in General Practice 9:35-10:30

More information

Nature and Science 2017;15(2) Recurrent urinary tract infection in girls: Risk factor.

Nature and Science 2017;15(2)  Recurrent urinary tract infection in girls: Risk factor. Recurrent urinary tract infection in girls: Risk factor Mohamed Kamel El Kholy 1, Magdy Mohamed Abd Elazez 1, Wael Refaat Abd El Hamed Hablas 2, Abul-Fotouh Abdel-Maguid Abul -Fotouh 1 and Mohamed Ahmed

More information

Index. urologic.theclinics.com. Note: Page numbers of article titles are in boldface type.

Index. urologic.theclinics.com. Note: Page numbers of article titles are in boldface type. Index Note: Page numbers of article titles are in boldface type. A Acinetobacter baumannii, carbapenem-resistant, 497 498 Adolescents, urinary tract infections in, 520 521 Aminoglycosides, for UTIs and

More information

Lower Urinary Tract Infection (UTI) in Males

Lower Urinary Tract Infection (UTI) in Males Lower Urinary Tract Infection (UTI) in Males Clinical presentation For patients in care homes see UTI in adults where IV Antibiotics in the community may be appropriate (under development) History and

More information

השפעת חיידקים פרוביוטיים

השפעת חיידקים פרוביוטיים השפעת חיידקים פרוביוטיים החיים בחלל )המעי(... על רון שאול יחידת גסטרו ילדים מרכז רפואי רמב"ם Introduction The intestinal microflora primarily in the large bowel consists mostly on benign bacterial species

More information

Clinically proven to quickly relieve symptoms of common gastrointestinal disorders. TERRAGASTRO - Good health starts in the gut

Clinically proven to quickly relieve symptoms of common gastrointestinal disorders. TERRAGASTRO - Good health starts in the gut Clinically proven to quickly relieve symptoms of common gastrointestinal disorders GASTROINTESTINAL DISEASE Referred to as gastrointestinal diseases, they are common disorders which affect the esophagus,

More information

The Effect of Cranberry Juice and Cranberry Derivatives on the Hemagglutination Activity of P-Fimbriated Escherichia coli

The Effect of Cranberry Juice and Cranberry Derivatives on the Hemagglutination Activity of P-Fimbriated Escherichia coli THE EFFECT OF CRANBERRY JUICE AND CRANBERRY DERIVATIVES ON THE HEMAGGLUTINATION ACTIVITY OF P-FIMBRIATED ESCHERICHIA COLI 409 The Effect of Cranberry Juice and Cranberry Derivatives on the Hemagglutination

More information

Urinary Tract Infection

Urinary Tract Infection 67 Urinary Tract Infection Dr Kawa Ahmad PhD Pharmaceutics 1 Introduction The term urinary tract infection (UTI) usually refers to the presence of organisms in the urinary tract together with symptoms,

More information

HMF Probiotics PROFESSIONAL PRODUCT GUIDE

HMF Probiotics PROFESSIONAL PRODUCT GUIDE HMF Probiotics PROFESSIONAL PRODUCT GUIDE NEW Research-driven Proprietary, human-sourced strains Visit wwwseroyalcom/genestrabrands to view the entire GENESTRA BRANDS line Scientifically sound, quality

More information

Drinking fluids and how they affect your bladder

Drinking fluids and how they affect your bladder www.olarts.com Drinking fluids and how they affect your bladder Contact us Patient Advice and Liaison Service (PALS) To make comments or raise concerns about the Trust s services, please contact PALS.

More information

PROBIONA. PROBIOTICS with 5 bacterial strains. Suitable during and after the use of antibiotics to restore intestinal microflora.

PROBIONA. PROBIOTICS with 5 bacterial strains. Suitable during and after the use of antibiotics to restore intestinal microflora. PROBIONA Probiotic supplement for adults PROBIOTICS with 5 bacterial strains Suitable during and after the use of antibiotics to restore intestinal microflora. 2.850 billion cfu per capsule guaranteed

More information

Bladder dysfunction in ALD and AMN

Bladder dysfunction in ALD and AMN Bladder dysfunction in ALD and AMN Sara Simeoni, MD Department of Uro-Neurology National Hospital for Neurology and Neurosurgery Queen Square, London 10:15 Dr Sara Simeoni- Bladder issues for AMN patients

More information

Philippine Clinical Practice Guidelines on the Diagnosis and Management of Urinary Tract Infections in Adults 2014 Update

Philippine Clinical Practice Guidelines on the Diagnosis and Management of Urinary Tract Infections in Adults 2014 Update -. Philippine Clinical Practice Guidelines on the Diagnosis and Management of Urinary Tract Infections in Adults 2014 Update Asymptomatic Bacteriuria and Recurrent Urinary Tract Infection 0 1 +. 2 3&40

More information

Children s Services Medical Guideline

Children s Services Medical Guideline See also: NICE Guidelines These local guidelines are in conjunction with NICE UTI Algorithms Renal scarring and subsequent nephropathy are important causes of later hypertension and renal failure. Early

More information

-Almost one third of cases admitted to medical centers are related to urinary tract infection

-Almost one third of cases admitted to medical centers are related to urinary tract infection Urinary tract infections: -Almost one third of cases admitted to medical centers are related to urinary tract infection -Urinary tract infection and respiratory infection together encompass about fifty

More information

by author Francisco López Medrano MD PhD Madrid, April 23 rd 2018

by author Francisco López Medrano MD PhD Madrid, April 23 rd 2018 Stubborn infections in transplant patients from recurrence to resistance Recurrent urinary tract infections in kidney transplant recipients Francisco López Medrano MD PhD Unit of Infectious Diseases University

More information

Gram-Negative rods Introduction to

Gram-Negative rods Introduction to Lec 5 Oral Microbiology Dr. Chatin Gram-Negative rods Introduction to Enterobacteriaceae Characteristics: جامعة تكريت كلية طب االسنان Small gram-negative rods (2-5 by 0.5 microns) Most motile with peritrichous

More information

Corporate Collaborations 2015

Corporate Collaborations 2015 Corporate Collaborations 2015 Franco Vicariotto, MD Dep.of vulvovaginal disease.hospital V.Buzzi University of Milan PROBIOTICAL S.P.A. Italy GUNA S.P.A. Italy MEDA ROTTAPHARM S.P.A. Italy PHARMASUISSE

More information

Year: Issue 1 Obs/Gyne The silent epidemic: Postmenopausal vaginal atrophy

Year: Issue 1 Obs/Gyne The silent epidemic: Postmenopausal vaginal atrophy Year: 2013 - Issue 1 Obs/Gyne The silent epidemic: Postmenopausal vaginal atrophy By: Dr David W Sturdee, Immediate past President International Menopause Society and Hon Consultant Gynaecologist, Solihull

More information

Probiotics: Their Role in Medicine Today. Objectives. Probiotics: What Are They? 11/3/2017

Probiotics: Their Role in Medicine Today. Objectives. Probiotics: What Are They? 11/3/2017 Probiotics: Their Role in Medicine Today Viki Barr Pharm.D., BCPS AQ ID Assistant Professor, Pharmacy Practice Rosalind Franklin University of Medicine and Science Clinical Pharmacist, Infectious Diseases

More information

International Journal of Ayurveda and Pharma Research

International Journal of Ayurveda and Pharma Research International Journal of Ayurveda and Pharma Research ISSN: 2322-0902 (P) ISSN: 2322-0910 (O) Research Article A PILOT STUDY ON THE EFFICACY OF SIDDHA MEDICINE SEENTHIL SARKARAI IN THE MANAGEMENT OF MOOTHIRAKIRICHARAM

More information

Outline. Urinary Tract Infection. Classification - UTI. Adult Genito-Urinary Infections Epidemiology, Etiology, and Diagnosis

Outline. Urinary Tract Infection. Classification - UTI. Adult Genito-Urinary Infections Epidemiology, Etiology, and Diagnosis Adult Genito-Urinary Infections Epidemiology, Etiology, and Diagnosis Geoffrey N. Box, M.D. Assistant Professor Director, Laparoscopic Urologic Surgery The Ohio State University Definitions: Urinary Tract

More information

UROPATHOGENS AND SUSCEPTIBILITY IN WOMEN WITH UNCOMPLICATED UTI IN PRIMARY CARE

UROPATHOGENS AND SUSCEPTIBILITY IN WOMEN WITH UNCOMPLICATED UTI IN PRIMARY CARE UROPATHOGENS AND SUSCEPTIBILITY IN WOMEN WITH UNCOMPLICATED UTI IN PRIMARY CARE Heytens Stefan 1 Claeys Geert² Christiaens Thierry 1 De Sutter An 1 (1) Department of family practice and general health

More information