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

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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 nonantimicrobial 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.

Citation: Rodriguez-Mañas L. Urinary tract infections in the elderly: a review of disease characteristics and current treatment options. Drugs in Context 2020; 9: 2020-4-13. DOI: 10.7573/dic.2020-4-13

Contributions: The named author meets the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, takes responsibility for the integrity of the work as a whole, and has given their approval for this version to be published.

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

Acknowledgements: Medical writing assistance was provided by Robert Furlong and Kerry Dechant of behalf of Content Ed Net (Madrid, Spain), with funding by Noventure SL, Barcelona, Spain. This manuscript is a review article and does not involve a research protocol requiring approval by the relevant institutional review board or ethics committee.

Funding declaration: Writing assistance was funded by Noventure SL, Barcelona, Spain.

Copyright: Copyright © 2020 Rodriguez-Mañas L. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2020 Rodriguez-Mañas L. https://doi.org/10.7573/dic.2020-4-13. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/urinary-tract-infections-in-the-elderly:-a-review-of-disease-characteristics-and-current-treatment-options

Correspondence: Leocadio Rodríguez Mañas, Servicio de Geriatría, Hospital Universitario de Getafe, Carr. Madrid – Toledo, 28905 Getafe, Madrid, Spain. leocadio.rodriguez@salud.madrid.org

Provenance: submitted; externally peer reviewed.

Submitted: 22 April 2020; Peer review comments to author: 18 May 2020; Revised manuscript received: 3 June 2020; Accepted: 5 June 2020; Publication date: 8 July 2020.

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