Older men are more likely to have an enlarged prostate, which leads to incomplete emptying of the


bladder.” — Stephen Eyre, M.D.,


chief of the urology division at Beth Israel Deaconess Hospital-Needham


prescription to keep at home for an antibiotic that can be started if they get their usual symptoms, until they can check in with their doctor,” Eyre says.


GETTING AN ACCURATE DIAGNOSIS


A dipstick urine test looks for products of white blood cells (leukocyte esterase) caused by a UTI or a chemical produced by bacteria called nitrite. A urinalysis can add identification of actual white blood cells. These tests can be helpful, but the


only sure way to test for a UTI is with a urine culture and sensitivity. “If both nitrites and white blood cell


products are not found, the chances of having a UTI are about zero,” Eyre says. “If in doubt, a culture and


sensitivity will give you actual bacteria identification and tell you which type of antibiotic will be most effective. “In reality, cultures are not always


needed. If an elderly patient has a history of recent uncomplicated UTIs in the last two months, and has the same symptoms, antibiotics can be started. The decision on when to culture can be based on a patient’s history.”


TARGETED TREATMENT If an antibiotic is needed, it should be based on culture results or targeted at the type of bacteria that


causes UTIs, the most common of which is E. coli. Broad-spectrum antibiotics


should not be taken for a UTI because these medicines kill many different types of bacteria and are more likely to cause resistant bacteria. For an uncomplicated UTI, most infections will respond to an oral antibiotic given twice a day for three to five days. Complicated UTIs may require a stronger, longer course, or intravenous antibiotic. “Another medication that may


be added for treatment of UTI symptoms is phenazopyridine. This medication turns your urine bright orange. It is only given for a few days to decrease bladder pain,” Eyre says. Brand names include Pyridium, Uristat, and Urogesic. Recurrent infections, defined


as three UTIs in the previous two months, may also be treated differently. “In patients with recurrent UTIs,


a daily dose of antibiotics may be prescribed for about six weeks. Another option is self-start therapy. “A patient can be given a


PREVENTION STRATEGIES


Some preventive options that have been used in the past, like probiotics and cranberry juice, have not stood up to recent studies. “A medication called methenamine


has shown some success. This medication works by coating the inside of the bladder, which prevents bacteria from penetrating and causing an infection. In men, medication to shrink the prostate may help,” Eyre says. If you or a loved one don’t have


obvious symptoms of a UTI, don’t start an antibiotic without a culture. A culture takes a day or two, but it is worth the wait if you don’t have classic symptoms. Antibiotic resistance is a serious problem. “Resistant bacteria limit the antibiotics you can use, especially oral antibiotics. You can burn through these quickly. A UTI may then need to be treated in the hospital with IV antibiotics, which exposes patients to other resistant hospital bacteria. It can be a dangerous and vicious cycle,” Eyre says.


NOVEMBER 2022 | NEWSMAX MAXLIFE 83


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