Linda fell into a pattern familiar to many women: a urine test would confirm an infection, and she'd start taking an antibiotic while waiting for the urine culture that would identify the microorganism and antibiotics to which it was sensitive. The antibiotics wouldn't get rid of the infection, and once again she'd be racing to the bathroom.
She hit the wall about 18 months ago, when the UTIs were "so frequent and so intense… it was really affecting my life." The infections curbed her business travel, left her so incapacitated "I felt myself totally disintegrate in terms of high fever, losing all my strength" and limited romantic encounters with her husband, who "couldn't quite figure out what to do to help."
At that point, she began coming to Penn, where Smith's nurse-practitioner confirmed Linda's suspicion that menopause might be contributing to the problem. They put her on a twice-weekly dose of Estrace, a vaginal estrogen more typically prescribed for vaginal dryness and painful intercourse; and twice-daily doses of an older drug called mandelamine (Hiprex), thought to keep bacteria from clinging to the walls of the urinary tract. She also took Vitamin C with the Hiprex because "the drug works best with an acidic urine environment," Smith said.
Linda said the treatment worked so well for six months that Smith weaned her off the drug for a while, but the symptoms came roaring back. Linda went back on the Estrace, Hiprex and Vitamin C, which have kept her clear of infection for six months.
"I'll stay with them for a year. My hope is that once I get completely through menopause, my symptoms will abate and I won't need to do that anymore."
Clinical trials have been exploring a variety of ways to combat UTIs:
PROBIOTIC SUPPOSITORIES: Dr. Ann E. Stapleton, a professor of medicine at the University of Washington in Seattle, has been studying the potential of a probiotic containing Lactobacillus crispatus, an organism in the vaginas of healthy women that protects against UTIs. In a series of studies, she and her colleagues have shown that L. crispatus produces hydrogen peroxide, suggesting "it's probably antiseptic," she said in an interview. They've followed UTI sufferers and proven that during an acute bladder or kidney infection, patients lose the protective lactobacilli, and that the lost lactobacilli don't return among women with recurrent UTIs. Stapleton and her colleagues are planning a Phase III trial of a lactobacillus vaginal suppository, called Lactin-V, to re-colonize patients' vaginas. They hope it will make it harder for E. coli to cause repeated infections. Scientists in Norway are studying a different vaginal probiotic, UREX-Cap-5, which contains two other Lactobacilli, L. rhamnosus and L. reuteri, and is sold in the United States as Fem-dophilus.