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Question: As a GP I am faced with an epidemic of patients with recurrent urinary tract infection. There are a number of non-bacterial treatments for UTI eg d-mannose, methenamine hippurate, cranberry - with varying evidence for them - any views from the panel on managing these patients? Antibiotic prophylaxis works, but I have obvious concerns about widespread use of this approach.
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Comments
athomson11 commented on :
It is useful to know about the RCGP module as these are normally really useful. Use of antibiotics for this indication does make up a notable amount of antibiotic prescribing and there can be a tendency for review and descalation in primary care to be overlooked. Some patients have sporadic patterns of ordering suggesting the need for review. In Scotland we had recently got support from dermatology specialist bodies to promote a 6mthly review for these anyone on longterm antibiotics (following the initial review phase obviously) – which is a start to start focusing primary care prescribers (similar to we have done with UTI prophylaxis recommending 6mthly review). Making sure this happens is always the challenge though but at least it gives us a benchmark to review against.
drjonrees commented on :
Thanks to all the experts for their answers!
All very useful – we desperately need good trials of non-antibiotic agents – I am glad to say we are a centre for the Atafuti trial that Michael mentioned, so will be watching that one with interest.
Chris mentioned probiotics – there are a number of different preparations out there – what do you use / recommend??
Cliodna mentions cranberry being supported by trial evidence – I have stopped recommending as I understood the Cochrane review was not supportive of cranberry.
Elizabeth commented on :
To add to the comments on use of probiotics – as poor evidence base choosing a product is going to be a challenge. CCG prescribing advisers would request patients are advised to purchase any probiotic products, unless the local formulary does include them.