Treatment of recurrent urinary tract infections in postmenopausal women

Abstract

Recurrent urinary tract infections (UTIs) are defined by three episodes in 12 months or two episodes in six months, and are much more common in women due to anatomical factors. Treating UTIs in the United States costs about $3.5 billion annually. Traditionally, UTIs are diagnosed based on the presence of more than 100,000 CFU/mL of urine and associated symptoms. With increasing age and antibiotic resistance, non-antimicrobial alternatives such as estrogen, probiotics, and vitamins have been proposed, but strong evidence is lacking. This study aims to evaluate the efficacy of continuous antibiotic prophylaxis and vaginal estrogens in the prevention of UTIs in postmenopausal women, with the aim of finding safer and more effective strategies for this population. This is a literature review focused on the treatment of recurrent urinary tract infections in postmenopausal women, with a qualitative and descriptive approach. The review follows a six-step methodology, from the formulation of the research question to the presentation of the results. The central question investigated was the efficacy of pharmacological interventions for the prevention of these infections. The data collection, carried out in September 2024, involved searching databases such as PubMed and Scielo, using specific descriptors. Original articles, available in Portuguese, English and Spanish, published in the last fifteen years were included, while editorials and studies outside the temporal scope were excluded. The results showed that antibiotic prophylaxis with trimethoprim, sulfamethoxazole and nitrofurantoin is effective in reducing infections, according to international guidelines. However, the use of vaginal estrogen has also shown significant benefits, especially for women with symptoms of vaginal atrophy. Despite these advances, the study has limitations, such as the lack of robust randomized controlled trials directly comparing systemic and vaginal estrogen. Future studies should include well-designed clinical trials to accurately assess the role of systemic estrogen and explore new therapies and combination strategies for the treatment of urinary tract infections in postmenopausal women.