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advised. Although creatinine clearance decreases with age, sulfamethoxazole in preventing UTIs in postmenopausal
dose reduction of medications based solely on the patient's women with uncomplicated UTIs, despite findings of micro-
age is not indicated. First-line treatments for cystitis are tri- organisms resistant to this medication .
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methoprim/sulfamethoxazole and nitrofurantoin, with the
note that nitrofurantoin (Table 1) is not effective against Preventing UTIs in individuals residing in specialized fa-
prostate and kidney infections, but only for lower urinary cilities hasn't been well described. Systemic estrogen admi-
tract infections. nistration and cranberry supplements haven't proven effe-
ctive as preventive strategies. The most important approach
Regarding causative agents of infection, Klebsiella pneu- is correcting any genitourinary abnormalities in cases of
moniae, Proteus mirabilis, and Pseudomonas aeruginosa are complicated UTIs. Prophylactic antimicrobial therapy hasn't
resistant to nitrofurantoin, while beta-lactamase-producing been protective against subsequent episodes of complica-
E. coli and vancomycin-resistant Enterococcus are sensitive ted UTIs. For patients with ASB undergoing genitourinary
to it. Although fluoroquinolones (such as norfloxacin, ci- procedures associated with bleeding, there's an increased
profloxacin, and levofloxacin) are effective in treating UTIs, risk of bacteremia and sepsis post-procedure, so prophyla-
their use is often limited by bacterial resistance . The use ctic antimicrobial therapy is advised immediately before the
26
of these types of medications should be reserved for cases intervention .
2
of empirical therapy in patients with a picture of pyelonep-
hritis, when there is resistance to other drugs, or when Adequate fluid intake is crucial in the prevention and tre-
patients do not tolerate other therapies. Oral therapy with atment of UTIs in the elderly. Older individuals may avoid
cephalosporins, fosfomycin, doxycycline, amoxicillin, and fluids to urinate less frequently, so it's important to explain
amoxicillin/clavulanic acid is the second-line therapy based the consequences of such habits. Other preventive measu-
on antimicrobial sensitivity and patient tolerance. res applicable to younger individuals also apply to the elder-
ly, primarily prompt urination immediately after feeling the
Parenteral therapy is indicated if the patient is he- urge to urinate.
modynamically unstable, if they do not tolerate oral thera-
py, and/or has uncertain absorption from the gastrointe-
stinal tract, or if the infection is resistant to the spectrum Specificities of urinary tract infection
of oral therapy. Parenteral therapy is administered during related to an indwelling catheter
the first 48-72 hours, after which the patient's condition is
reevaluated, and treatment may be continued with oral the- Literature data indicate a high frequency of permanent
rapy if appropriate. If aminoglycosides are administered for urinary catheters in residents of homes for the elderly
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more than 7 days, it is necessary to monitor the drug levels persons . According to data from America, approximately
in the blood and kidney function. 13% of individuals admitted to nursing homes have an in-
dwelling catheter, with 16% of men and 3% of women be-
It has been shown that in women with an average age of ing users in 67 nursing homes in Sweden . These patients
30
78.5 years, the treatment outcomes are the same whether always have bacteriuria, and symptomatic UTI occurs 2.2
ciprofloxacin is administered for three or five days . Additi- times more frequently, while bacteremia is up to 39 times
26
onally, the use of trimethoprim/sulfamethoxazole for three more common than in individuals without a catheter 23, 31 .
days and nitrofurantoin for five days has favorable outco- Also, autopsy findings of acute pyelonephritis are eight ti-
mes. mes more common in catheterized individuals. However,
increased mortality in nursing home residents is more likely
due to functional impairment and comorbidities rather than
Prevention urinary tract infections.
Long-term antimicrobial prophylaxis can prevent the The most important pathogenetic mechanism in the de-
onset of acute uncomplicated infections in older women in velopment of bacteriuria and UTI in individuals with a cathe-
outpatient settings. The first-line therapy is nitrofurantoin ter is the formation of a biofilm shortly after catheter place-
50 or 100 mg per day or trimethoprim/sulfamethoxazole ment . Microorganisms immediately adhere to the surface
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half a tablet daily or every other day. The initial duration of of the catheter and multiply on both the external and inter-
prophylaxis is 6 to 12 months. Although there is evidence nal sides, creating polysaccharides. Urine components such
that local estrogen administration can reduce the frequen- as Tamm-Horsfall protein, calcium ions, and magnesium
cy of UTIs in women, this prevention method has been less ions also contribute to biofilm formation by incorporating
successful than nitrofurantoin prophylaxis . them into it. Microcolonies within the biofilm are protected,
27
making it difficult for antibiotics and local defense factors
A prospective cohort study did not confirm a positive such as leukocytes and immunoglobulins to penetrate . Al-
33
effect of cranberry-based products in women aged 55-75 kalization of urine by urease-producing bacteria promotes
years . The use of cranberry juice was less effective than tri- the deposition of calcium and magnesium salts, resulting in
13
methoprim and compared to placebo. Additionally, Lactoba- the formation of a crystalline biofilm. This crystalline biofilm
cillus was also significantly less effective than trimethoprim/

REVIEW PAPER Galenika Medical Journal, 2024; 3(9):48-53. 51