Disabled Traveler: Status of treatments for Urinary Tract Infections With Emphasis On Wheelchair Users

Many Urinary Tract Infections (UTI) are fairly common, particularly for people with conditions or diseases that keep them in a wheelchair such as Spinal cord Injuries or Multiple Sclerosis because individuals may have bladder storage and/or voiding dysfunction [1]. Many times the infections are associated with the use of catheters. Diabetes is also often associated with UTIs. [2,3] Since many UTIs recur, the questions your doctor has to struggle with, and you to be thinking about, usually boil down to:

1. How many times can the the usual antibiotics be prescribed and maintain efficacy as well as keeping possible side effects at bay.
2. Is this a "simple" or a "complicated" UTI?

_This post is not meant to alarm you, but on the contrary to describe the arsenal your Doctor has to deal with UTIs, should the need arise._

* Antibiotics are probably the most common treatment:

> * Quinolones have been extensively prescribed but there are some safety issues [2] : "Fluoroquinolone toxicity[190][191] or quinolone toxicity is the long term or serious physical and mental ADRs that can occur from use of fluoroquinolones." An example is ciprofloxacin [3], which is a fluoroquinolone and is often prescribed for UTIs
> * Other studies sometimes recommend substitutes for the quinolones [4] "Uncomplicated UTI is classified as either uncomplicated cystitis (UC) or uncomplicated pyelonephritis (UP)….co-trimoxazole/trimethoprim and fluoroquinolones can no longer be recommended as first-line empirical treatment for UC. Rather, the new recommended treatment of first choice consists of fosfomycin-trometamol, nitrofurantoin, or pivmecillinam…High-dose fluoroquinolones are still recommended, however, as first-line oral treatment for UP." _So you should find out from your Doctor which type of UTI you have: UC or UP._

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UTI are often a side effect of constant wheelchair use

Then other approaches are currently studied:

* Botulinum toxin type A [5] : this treatment aims at better control of the urine flow by the Detrusor urinae muscle: "…A (Botox) for injection for the treatment of urinary incontinence as a result of neurogenic detrusor overactivity (e.g. spinal cord injury, multiple sclerosis) in adults…". This probably assumes that the patient still has a modicum of detrusor control and is meant to treat mainly muscular hypercontraction. Since a lot of the UTIs have to do with inadequate urinary flow, some improvement of the UTIs concomitant with the better detruser control could be expected.

* Bacterial interference [7] is an approach which reminds us of the current probiotic craze in nutrition: "benign bacterial strains were studied with the objective of offering some protection against invasion by uropathogenic strains."

Note: According to [3] "The increased incidence, prevalence and severity of urinary tract infection in patients with diabetes argue for aggressive antibacterial chemotherapy" Keeping in mind that "…Studies have reported rates of diabetes from 13% to 22% in persons with an SCI.." [10]

Are there some natural therapies against UTIs, most of us have heard of Cranberries and cranberry juice. Are there any proofs? We provide references to two studies that think so [11,12]. The principle is that cranberry uses physics to decrease the adherence of the bacteria the the bladder wall. Seems that it works but is certainly less efficacious than antibiotics. Then again , since the accent is on prevention, might be worth a try.

_**Talk to your Doctor**_

Sources:

[1] [British Journal Of Community Nursing][3] ; "Lower urinary tract dysfunction in MS: management in the community."; 2009

[2][ American Journal of Medicine][4] ; "Pathogenesis of bacteriuria and infection in the spinal cord injured patient"; 2002

[3][ Journal of Urology][5] ; "Diabetes mellitus and urinary tract infection: epidemiology, pathogenesis and proposed studies"; 2009

[4] [Wikipedia/quinolones][6]

[5] [Wikipedia/ciprofloxacin][7]

[6] [Dtsch Arztebl Int.;][8] 2011 Jun ; "Uncomplicated urinary tract infections." ; 2011

[7][ International Journal Of Urology ;][9] "Botulinum toxin type A for the treatment of lower urinary tract disorders." ; 2012

[8] [Journal Of Spinal cord Medicine ; ][10]"Bacterial interference for prevention of urinary tract infection: an overview"

[9] [American Journal of Medicine][4] ; "Pathogenesis of bacteriuria and infection in the spinal cord injured patient."

[10] [Journal of Spinal Cord Injury][11] ; "Diabetes Mellitus in Individuals With Spinal Cord Injury or Disorder "; 2006

[11] [Archive of Internal Medicine][12] ;"Cranberries vs antibiotics to prevent urinary tract infections: a randomized double-blind noninferiority trial in premenopausal women.

[12] [Journal of Medicinal Food ][13];" Role of cranberry on bacterial adhesion forces and implications for Escherichia coli-uroepithelial cell attachment."

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URL: http://www.medinewsdigest.com/?p=3524

Wednesday, January 11, 2012

Status of treatments for Urinary Tract Infections With Emphasis On Wheelchair Users

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