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Review
. 2020 Jul 8:9:2020-4-13.
doi: 10.7573/dic.2020-4-13. eCollection 2020.

Urinary tract infections in the elderly: a review of disease characteristics and current treatment options

Leocadio Rodriguez-Mañas  1
Affiliations
Review

Urinary tract infections in the elderly: a review of disease characteristics and current treatment options

Leocadio Rodriguez-Mañas. Drugs Context. .

Abstract

Urinary tract infections (UTIs) are common in the elderly, and cover a range of conditions from asymptomatic bacteriuria to urosepsis. Risk factors for developing symptomatic UTIs include immunosenescence, exposure to nosocomial pathogens, multiple comorbidities, and a history of UTIs. European guidelines on urological infections recommend antimicrobial treatment only for symptomatic UTIs. Non-antimicrobial options to treat and prevent UTIs include among others cranberry products, OM-89 Escherichia coli bacterial lysate vaccine, and estrogen therapy in postmenopausal women, although evidence for their efficacy is weak. Another non-antimicrobial option to control and prevent UTIs is a medical device (Utipro Plus®) containing xyloglucan, gelatin, propolis, and extracts of Hibiscus sabdariffa. The device acts in the intestine as a mechanical barrier to protect against invasion by uropathogenic E. coli strains. A randomized controlled trial of Utipro Plus® in patients with uncomplicated UTIs provided good-quality evidence of its efficacy compared with placebo. In an observational study of Utipro Plus® in patients with recurrent UTIs, more than 80% women reported a return to their pre-UTI clinical status and about 30% transitioned from symptomatic UTIs to asymptomatic bacteriuria. New treatment strategies that offer a safe and effective non-antimicrobial means of managing UTIs could have an important role in the elderly.

Keywords: elderly patients; medical device; non-antimicrobial treatment; urinary tract infections.

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Conflict of interest statement

Disclosure and potential conflicts of interest: The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2020/06/dic.2020-4-13-COI.pdf

Figures

Figure 1
Figure 1
Uncomplicated and complicated urinary tract infection (UTI) defined by the European Association of Urology using ORENUC. ORENUC: O, NO known factors; R, Risk for Recurrent UTI; E, Extra urogenital risk factors; N, Nephropathy; U, Urological risk factors that can be resolved by therapy; C, catheter and risk factors that cannot be resolved by therapy. Reproduced from Bonkat et al. with permission.
See this image and copyright information in PMC

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