Modern approaches to the management of recurrent urinary tract infections in women

In the recent years, relapses of infectious and inflammatory diseases of the urinary tract (UTI) have become more common. Doctors in many specialties face the problem of recurrent UTIs. The effectiveness of antibiotics is worsening, while antibiotic resistance is increasing. This review article deals with prevention and treatment of patients with recurrent UTIs. Risk factors for recurrent UTIs are reviewed separately for women in their pre- and post-menopausal age. Based on the literature and our own experience, we discuss therapeutic and preventive measures for these disorders. Today, preventive measures for recurrent UTIs involve not only lifestyle modification, herbal treatments and improvement of immune response, but also vaginal estrogen replacement therapy in postmenopausal women, immune prophylaxis, normalization of urinary output, water-induced diuresis, urine acidification, vaginal application of the lactobacilli, long-term low-dose and/or postcoital drug prophylaxis in various combinations. It is emphasized, that current guidelines on the prevention of recurrent UTIs are primarily focused on non-antibiotic measures. However, the necessary prerequisite or initiation of any prevention regimen is a negative urine culture after the eradication of the pathogen. A list of the most common herbal preparations is included into the review. Immunoactive prophylaxis and stimulation of an individual immune response is considered to be a new strategy in the management of patients with recurrent UTIs. Characteristics of antibacterials are given from the evidence-based perspective. Individual and sexual hygiene are both important conditions for the successful prevention of UTI relapses and successful treatment of recurrent UTIs