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Prophylaxe rezidivierender Harnwegsinfektionen

Prophylaxis of recurrent urinary tract infections

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Zusammenfassung

Hintergrund

Meist sind junge oder postmenopausale Frauen von rezidivierenden Harnwegsinfektionen (rHWI; ≥ 3 HWI/Jahr) betroffen. Oft findet man keine therapierbaren Ursachen. Verhaltensempfehlungen reduzieren die Rezidivrate auf bis zu zwei Drittel.

Methode

Eine kontinuierliche niedrig dosierte Langzeitprophylaxe (LP) mit Antibiotika oder eine postkoitale Einmaldosis senken die Rezidivrate auf bis zu 5 %. Gemäß den Leitlinien der Europäischen Gesellschaft für Urologie sollten Nitrofurantoin, Trimethoprim oder Cotrimoxazol, bei speziellen Indikationen Cephalosporine oder Fluorochinolone, eingesetzt werden. Die orale bzw. parenterale Immunprophylaxe stellt eine Alternative zur LP von rHWI dar, wenn eine Stärkung der Immunkompetenz sinnvoll ist und/oder eine antibiotische LP nicht durchgeführt werden kann. Eine Estriol-Substitution zur LP, die am besten lokal durchgeführt wird, hat in der Postmenopause meist keine Nebenwirkungen.

Schlussfolgerung

Trotz positiver Evidenz der LP mit Cranberries ist die optimale Form der Therapie noch zu klären. Die Wertigkeit weiterer Ansätze wie Phytotherapeutika, Mannose, Harnansäuerung, die Beeinflussung der Bakterien in Darm oder Vagina oder eine Immunstimulation durch Akupunktur und stationäre Rehabilitation ist noch unklar.

Abstract

Background

Recurrent urinary tract infections (rUTI), defined as ≥3 UTIs per year, mostly affect young and postmenopausal women. Treatable predisposing factors are rare.

Methods

General recommendations to reduce rUTIs lower the recurrence rate by up to approximately two thirds. Continuous long-term prophylaxis (LP) with low dose antibiotics or single postcoital doses can reduce the recurrence rate of rUTIs to as low as 5%. According to the European Association of Urology guidelines nitrofurantoin, trimethoprim and co-trimoxazole are the first-line drugs and cephalosporins or fluoroquinolones should be restricted to specific indications. Oral and parenteral immunotherapy were found to be effective in several controlled studies for prevention of rUTIs and can be combined with acute antibiotic therapy.

Conclusions

Vaginal prophylaxis with estriol has proven its positive effect without serious gynecological side effects and there is also increasing evidence that cranberries prevent rUTIs but the exact mode of this therapy remains to be defined. There are also other promising modalities, such as phytotherapeutics, mannose, urine acidification, influencing bacterial intestinal and vaginal flora and the general immune response by e.g. acupuncture and inpatient rehabilitation, the therapeutic value of which still has to be proven.

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Literatur

  1. Abad CL, Safdar N (2009) The role of lactobacillus probiotics in the treatment or prevention of urogenital infections – a systematic review. J Chemother 21(3):243–252

    Article  PubMed  CAS  Google Scholar 

  2. Albrecht U, Goos KH, Schneider B (2007) A randomised, double-blind, placebo-controlled trial of a herbal medicinal product containing Tropaeoli majoris herba (Nasturtium) and Armoraciae rusticanae radix (Horseradish) for the prophylactic treatment of patients with chronically recurrent lower urinary tract infections. Curr Med Res Opin 23(10):2415–2422

    Article  PubMed  Google Scholar 

  3. Amiri FN, Rooshan MH, Ahmady MH, Soliamani MJ (2009) Hygiene practices and sexual activity associated with urinary tract infection in pregnant women. East Mediterr Health J 15(1):104–110

    PubMed  CAS  Google Scholar 

  4. Aune A, Alraek T, LiHua H, Baerheim A (1998) Acupuncture in the prophylaxis of recurrent lower urinary tract infection in adult women. Scand J Prim Health Care 16(1):37–39

    Article  PubMed  CAS  Google Scholar 

  5. Baerheim A, Laerum E (1992) Symptomatic lower urinary tract infection induced by cooling of the feet. Scand J Prim Health Care 10:157–160

    Article  PubMed  CAS  Google Scholar 

  6. Barbosa-Cesnik C, Brown MB, Buxton M et al (2011) Cranberry juice fails to prevent recurrent urinary tract infection: results from a randomized placebo-controlled trial. Clin Infect Dis 52(1):23–30

    Article  PubMed  PubMed Central  Google Scholar 

  7. Bauer HW, Rahlfs VW, Lauener PA, Bleßmann GS (2002) Prevention of recurrent urinary tract infections with immunoactive E. coli fractions: a meta-analysis of five placebo-controlled double-blind studies. Int J Antimicrob Agents 19(6):451–456

    Article  PubMed  CAS  Google Scholar 

  8. Bauer HW, Alloussi S, Egger G et al (2005) A long-term, multicenter, double-blind study of an Escherichia coli extract (OM-89) in female patients with recurrent urinary tract infections. Eur Urol 47:542–548

    Article  PubMed  Google Scholar 

  9. Beerepoot MA, ter Riet G, Nys S et al (2011) Cranberries vs antibiotics to prevent urinary tract infections: a randomized double-blind noninferiority trial in premenopausal women. Arch Intern Med 171(14):1270–1278

    Article  PubMed  Google Scholar 

  10. Bojana Kranjcec B, Papes D, Altarac S (2013) D-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial. World J Urol. doi:10.1007/s00345-013-1091-6

  11. Borchert D, Sheridan L, Papatsoris A et al (2008) Prevention and treatment of urinary tract infection with probiotics: review and research perspective. Indian J Urol 24(2):139–144

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  12. Damiano R, Quarto G, Bava I et al (2011) Prevention of recurrent urinary tract infections by intravesical administration of Hyaluronic acid and Chondroitin sulphate: a placebo-controlled randomised trial. Eur Urol 59:645–651

    Article  PubMed  CAS  Google Scholar 

  13. Falagas ME, Betsi GI, Tokas T, Athanasiou S (2006) Probiotics for prevention of recurrent urinary tract infections in women. Drugs 66(9):1253–1261

    Article  PubMed  Google Scholar 

  14. Fünfstück R, Straube E, Schildbach O, Tietz U (1997) Reinfektionsprophylaxe durch L-Methionin bei Patienten mit einer rezidivierenden Harnwegsinfektion. Med Klin 92:574–581

    Article  Google Scholar 

  15. Grabe M, Bjerklund-Johansen TE, Botto H et al (2013) Guidelines on urological infections. EAU Guidelines. European Association of Urology, Arnhem, The Netherlands

  16. Greenberg JA, Newmann SJ, Howell AB (2005) Consumption of sweetened dried cranberries versus unsweetened raisins for inhibition of uropathogenic Escherichia coli adhesion in human urine: a pilot study. J Altern Complement Med 11(5):875–878

    Article  PubMed  Google Scholar 

  17. Iavazzo C, Athanasiou S, Pitsouni E, Falagas ME (2007) Hyaluronic acid: an effective alternative treatment of interstitial cystitis, recurrent urinary tract infections, and hemorrhagic cystitis? Eur Urol 51:1534–1541

    Article  PubMed  CAS  Google Scholar 

  18. Jepson RG, Williams G, Craig JC (2012) Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev 10:CD001321. doi:10.1002/14651858.CD001321.pub5

    PubMed  Google Scholar 

  19. Kontiokari T, Sundqvist K, Nuutinen M et al (2001) Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women. Br Med J 322:1571–1573

    Article  CAS  Google Scholar 

  20. Larsson B, Jonasson A, Fianu S (1993) Prophylactic effect of UVA-E in women with recurrent cystitis: a preliminary report. Curr Ther Res 53(4):441–443

    Article  Google Scholar 

  21. Lettgen B (1996) Prophylaxe rezidivierender Harnwegsinfektionen bei Mädchen. Curr Ther Res 57(6):463–475

    Article  Google Scholar 

  22. Ludwig M, Hoyme UB, Weidner W (2006) Rezidivierende Harnwegsinfektionen der Frau – Antibiotische Langzeitprophylaxe. Urologe 45:436–442

    Article  PubMed  CAS  Google Scholar 

  23. McMurdo ME, Argo I, Phillips G et al (2009) Cranberry or Trimethoprim for the prevention of recurrent urinary tract infections? A randomized controlled trial in older women. J Antimicrob Chemother 63(2):389–395

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  24. Minardi D, d’Anzeo G, Cantoro A, Muzzonigro G (2011) Urinary tract infections in women: etiology and treatment options. Int J Gen Med 4:333–343

    Article  PubMed  PubMed Central  Google Scholar 

  25. Moorman CN, Fowler JE (1992) Impact of site release vaginal pH-buffer cream on introital colonization by gram-negative bacilli. J Urol 147:1576–1578

    PubMed  CAS  Google Scholar 

  26. Naber KG, Cho YH, Matsumoto T, Schaeffer AJ (2009) Immunoactive prophylaxis of recurrent urinary tract infections: a meta-analysis. Int J Antimicrob Agents 33(2):111–119

    Article  PubMed  CAS  Google Scholar 

  27. Naber KG (2013) Efficacy and safety of the phytotherapeutic drug Canephron® N in prevention and treatment of urogenital and gestational disease: review of clinical experience in Eastern Europe. Res Rep Urol 5:39–46

    PubMed  CAS  PubMed Central  Google Scholar 

  28. Perrota C, Aznar M, Mejia R et al (2008) Oestrogens for preventing recurrent urinary tract infection in postmenopausal women. Cochrane Database Syst Rev 2:CD005131

    Google Scholar 

  29. Pinggera GM, Herwig R, Feuchtner G et al (2003) Local Estrogen therapy in management of recurrent urinary tract infections in young females. J Urol 169(4 Suppl):10

    Google Scholar 

  30. Raz R, Colodner R, Rohanna Y et al (2003) Effectiveness of Estriol-containing vaginal pessaries and Nitrofurantoin macrocrystal therapy in the prevention of recurrent urinary tract infection in postmenopausal women. Clin Infect Dis 36:1362–1368

    Article  PubMed  CAS  Google Scholar 

  31. Robinson D, Cardozo L (2011) Estrogens and the lower urinary tract. Neurourol Urodyn 30:754–757

    Article  PubMed  CAS  Google Scholar 

  32. Rudenko N, Dorofeyev A (2005) Prevention of recurrent lower urinary tract infections by long-term administration of Fosfomycin trometamol. Double blind, randomized, parallel group, placebo controlled study. Arzneimittelforschung 55:420–427

    PubMed  CAS  Google Scholar 

  33. Scholes D, Hooton TM, Roberts PL et al (2000) Risk factors for recurrent urinary tract infection in young women. J Infect Dis 182:1177–1182

    Article  PubMed  CAS  Google Scholar 

  34. Scholes D, Hooton TM, Roberts PL et al (2005) Risk factors associated with acute pyelonephritis in healthy women. Ann Intern Med 142:20–28

    Article  PubMed  PubMed Central  Google Scholar 

  35. Stapleton AE, Dziura J, Hooton TM et al (2012) Recurrent urinary tract infection and urinary Escherichia coli in women ingesting cranberry juice daily: a randomized controlled trial. Mayo Clin Proc 87(2):143–150

    Article  PubMed  PubMed Central  Google Scholar 

  36. Stapleton AE, Au-Yeung M, Hooton TM et al (2011) Randomized, placebo-controlled phase 2 trial of a Lactobacillus crispatus probiotic given intravaginally for prevention of recurrent urinary tract infection. Clin Infect Dis 52(10):1212–1217

    Article  PubMed  PubMed Central  Google Scholar 

  37. Su SB, Wang JN, Lu CW, Guo HR (2006) Reducing urinary tract infections among female clean room workers. J Womens Health (Larchmt) 15(7):870–876

    Article  Google Scholar 

  38. Vahlensieck W Jr (1999) Prophylaxemaßnahmen bei rezidivierenden Harnwegsinfektionen. In: Hofstetter A (Hrsg) Urogenitale Infektionen. Springer, Berlin Heidelberg New York, S 215–239

  39. Vahlensieck W, Naber K (2004) Lokale Infektionsprophylaxe und -therapie am Harntrakt mit antibakteriellen Substanzen (Antibiotika, Hohlraumchemotherapeutika oder Antiseptika). In: Adam D, Doerr HW, Link H, Lode H (Hrsg) Die Infektiologie. Springer, Berlin Heidelberg New York, S 161–166

  40. Vahlensieck W, Bauer H-W (2012) Vorbeugende Therapie chronisch rezidivierender Harnwegsinfektionen (rHWI). Med Welt 63:185–190

    Google Scholar 

  41. Vahlensieck W, Bauer H-W, Hoyme UB et al (2007) Prophylaxe rezidivierender Harnwegsinfektionen (rHWI). Nieren Hochdruckkrankheiten 36(10):501–513

    Article  Google Scholar 

  42. Wagenlehner FME, Vahlensieck W, Bauer H-W et al (2011) Primar- und Sekundärprävention von Harnwegsinfektionen. Urologe 50:1248–1256

    Article  PubMed  CAS  Google Scholar 

  43. Wenderlein M (2010) Lokale Östrioltherapie. Dtsch Ärztebl 107(47):841

    Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. W. Vahlensieck: Berater – Bionorica, Lilly, Omega/Abtei, Pfizer. Vortrags-/Publikationshonorare – CGC Cramer Gesundheitsconsulting, Fischerappelt, Infectopharm, Pfleger, Strathmann. H.-W. Bauer, H.J. Piechota, M. Ludwig und F. Wagenlehner geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Fachklinik Urologie, Kurpark-Klinik, Kurstraße 41–45, 61231, Bad Nauheim, Deutschland

    W. Vahlensieck

  2. Urologische Praxis München, München, Deutschland

    H.-W. Bauer

  3. Klinik für Urologie, Pädiatrische Urologie und urologische Onkologie, Johannes Wesling-Klinikum Minden, Minden, Deutschland

    H.J. Piechota

  4. Urologische Praxis Marburg, Marburg, Deutschland

    M. Ludwig

  5. Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, UKGM GmbH, Standort Gießen, Justus-Liebig-Universität Gießen, Gießen, Deutschland

    F. Wagenlehner

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  1. W. Vahlensieck
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  3. H.J. Piechota
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  4. M. Ludwig
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  5. F. Wagenlehner
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Correspondence to W. Vahlensieck.

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Vahlensieck, W., Bauer, HW., Piechota, H. et al. Prophylaxe rezidivierender Harnwegsinfektionen. Urologe 53, 1468–1475 (2014). https://doi.org/10.1007/s00120-014-3562-9

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