SNAPPS Template for Written Assignment May 2018_1

SNAPPS Template for Written
Assignment May 2018_1
SNAPPS WRITTEN ASSIGNMENT TEMPLATE

What is the self-directed learning issue that was identified in your oral presentation?

Management of Recurrent Urinary Tract Infection in Women

Research the self-directed learning issue and provide a summary of your findings which is fully
supported by appropriate, scholarly, EBM references.

Urinary tract infections (UTIs) are one of the most frequent clinical bacterial infections in
women, accounting for nearly 25% of all infections. Around 50–60% of women will develop
UTIs in their lifetimes. Approximately 20%–30% of women with a urinary tract infection (UTI)
will have a recurrence. Escherichia coli is the organism that causes UTIs in most patients (Al-
Badr & Al-Shaikh, 2013). Although the initial treatment is antimicrobial therapy, use of different
prophylactic regimens and alternative strategies are available to reduce exposure to
antibiotics. RUTIs can reduce quality of life and increase healthcare costs associated with
outpatient visits, diagnostic tests and prescription.




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Recurrent UTIs (rUTIs) can be defined as at least three episodes of UTI in 1 year or two




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episodes in 6 months. Various antibiotics have been the mainstay of therapy in ameliorating
the incidence of UTIs, but recurrent infections continue to afflict many women. It necessitates




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the exploitation of alternative antimicrobial therapy. Probiotics have been shown to be
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effective in varied clinical trials for long-term preventions of recurrent UTI. Because
ou urc
Escherichia coli is the primary pathogen involved in UTIs which spreads from the rectum to
vagina and then ascends the sterile urinary tract, improving the gut or vaginal flora will thus
impact the urinary tract (Gupta et, al., 2017).
o

Clinicians should obtain a complete patient history and perform a pelvic examination in
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women presenting with rUTI. Women with RUTIs need to be properly investigated by
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urinalysis, urine cultures and other radiological techniques in order to rule out causes of
recurrence, as well as to assess possible anatomical or functional urinary tract abnormalities.
Although standard UTI therapy starts with antimicrobial therapy, alternative strategies are
available to reduce exposure to antibiotics, such as the use of methenamine salts, probiotics,
ed d




cranberry juice, immunoprophylaxis and vaginal estrogens in post-menopausal women. In
ar stu




peri– and post–menopausal women with Recurrent UTIs, clinicians should recommend
vaginal estrogen therapy to reduce the risk of future UTIs if there is no contraindication to
estrogen therapy. (Moderate Recommendation; Evidence Level Continuous antibiotic
prophylaxis, postcoital prophylaxis, and acute self-treatment are cost-effective treatment
is




strategies for reducing the number of RUTIs in some patients.
Th




Evidence suggests that many recurrences of UTI may actually be caused by an underlying
bladder infection that came about due to ineffective initial treatment (Swami et, al., 2018).
Treating UTI might not be difficult but preventing UTI recurrence sometimes might be very
troublesome for both patients and doctors. Recent research has revealed many novel
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concepts in recurrent UTI, including the pathogenesis, risk factors, biomarkers, and
prevention. The management of recurrent UTI is the same as that for sporadic UTI except
that the likelihood of infection with an antibiotic resistant uropathogen is higher in women who
have received recent antimicrobials. Strategies to prevent recurrent UTI in young women
should include education about the association of recurrent UTI with frequency of sexual
intercourse and the usage of spermicide-containing products. Continuous or post-coital



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