Doctors typically follow treatment guidelines that quickly become obsolete as bacterial resistance evolves, contends Dr. Anthony J. Schaeffer, chairman of urology at Northwestern University Feinberg School of Medicine in Chicago. He's using a tool called data-mining to improve the way doctors select the drugs for patients with UTIs.
In findings presented at the American Urological Association meeting in 2010, he and his colleagues showed that theoretical models based upon a database of 3,567 positive urine cultures from Northwestern urology clinic patients, which included their age, race, ZIP code, antibiotic susceptibilities and prior UTI history, produced 10 percent to 15 percent improvements in selecting the optimal therapy, Schaeffer said. Northwestern has patented the technique.
"It's pretty dramatic," Schaeffer said of how the data-mining better matched bacterial strains to one of three drugs most commonly prescribed for UTIs: ciprofloxacin (Cipro), nitrofurantoin (Macrodantin) and trimethoprim-sulfamethoxazole (Bactrim, Septra). "What's exciting about this is there's no added cost. You're not prescribing a more expensive drug, it's just picking the right drug."
For patients repeatedly infected by the same bacterial strain, Schaeffer prescribes one of three treatments:
Prophylactic nightly doses of medication to prevent, rather than suppress the bugs.
Single doses of antimicrobials taken "at the time of intercourse."
The "self-start therapy" he described in a 1999 paper, which allows patients to "do their own culture, start their own treatment and make a post-treatment follow-up." Although Northwestern frequently uses this approach because it facilitates prompt treatment, Schaeffer said it's not widely used because of difficulties with obtaining "devices for performing the cultures at home."
For her part, Penn's Smith said, "When women start taking antibiotics, you can start talking to them about things they can do to protect themselves" from the cycle of UTIs and yeast infections. That includes eating lactobacillus-rich yogurt or taking lactobacillus pills, which she uses "to treat patients who come in with these recurrent, cyclic problems – even though there isn't a lot of data to support it."
Smith is meticulous about seeing patients to document the cause of their infections, having them complete courses of antibiotics before she'll consider additional therapy, and turning to some less-studied, but anecdotally effective treatments, especially for her menopausal patients.
Those are what finally worked for Linda, 51, a Philadelphia attorney who began suffering the pain, disability and high fevers of recurrent UTIs only in the last five years, after menopause began. Linda, who asked that her full name not be used, said she tried virtually every over-the-counter, prescription and kitchen remedy, even taking her mother's advice to "drink gallons and gallons of fluid." All that drinking only gave her temporary relief.
"You'll try anything," she said. "I spent one vacation at the beach, rolled in a blanket for five or six days, and was on three antibiotics by the time I actually went home."