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Prevention of recurrent urinary tract infections: bridging the gap between clinical practice and guidelines in Latin America

The branches of the immune system work in concert to defend against pathogens and prevent tissue damage due to excessive inflammation. Uropathogens in general, and uropathogenic Escherichia coli (UPEC) in particular, have evolved a diverse range of virulence mechanisms to avoid detection and destruc...

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Autores principales: Ortega Martell, José Antonio, Naber, Kurt G., Milhem Haddad, Jorge, Tirán Saucedo, José, Domínguez Burgos, Jesús Alfonso
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502980/
https://www.ncbi.nlm.nih.gov/pubmed/31105773
http://dx.doi.org/10.1177/1756287218824089
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author Ortega Martell, José Antonio
Naber, Kurt G.
Milhem Haddad, Jorge
Tirán Saucedo, José
Domínguez Burgos, Jesús Alfonso
author_facet Ortega Martell, José Antonio
Naber, Kurt G.
Milhem Haddad, Jorge
Tirán Saucedo, José
Domínguez Burgos, Jesús Alfonso
author_sort Ortega Martell, José Antonio
collection PubMed
description The branches of the immune system work in concert to defend against pathogens and prevent tissue damage due to excessive inflammation. Uropathogens in general, and uropathogenic Escherichia coli (UPEC) in particular, have evolved a diverse range of virulence mechanisms to avoid detection and destruction by the mucosal immune system of the urinary tract. Research towards a vaccine active against UPEC continues but has yet to be successful. Orally administered immunomodulatory bacterial lysates both stimulate and modulate the immune response in the urinary tract via the integrated mucosal immune system. The 2018 European Association of Urology (EAU) guidelines on treating acute uncomplicated cystitis recommend aiming for rapid resolution of symptoms, reduction of morbidity, and prophylaxis against reinfection. Recommended short-term antibiotic therapy has the advantage of good compliance, low cost, few adverse events, and low impact on bacterial flora. Antibiotic treatment of asymptomatic bacteriuria is only indicated during pregnancy and before invasive interventions. For recurrent infection, prophylaxis using behavioral modification and counseling should be employed first, then nonantibiotic prophylaxis, and, finally, low-dose continuous or postcoital antibiotic prophylaxis. The 2018 EAU guidelines give a strong recommendation for the oral bacterial lysate immunomodulator OM-89. All other nonantibiotic prophylactic strategies require more data, except for topical estrogen for postmenopausal women. For last-resort antibiotic prophylaxis, nitrofurantoin or fosfomycin trometamol are recommended. Guidelines for Latin America are currently being drafted, taking into account the unique ethnicity, availability of medicines, prevalence of antibiotic resistance, and healthcare practices found throughout the region.
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spelling pubmed-65029802019-05-17 Prevention of recurrent urinary tract infections: bridging the gap between clinical practice and guidelines in Latin America Ortega Martell, José Antonio Naber, Kurt G. Milhem Haddad, Jorge Tirán Saucedo, José Domínguez Burgos, Jesús Alfonso Ther Adv Urol Supplement 11 Issue 1S The branches of the immune system work in concert to defend against pathogens and prevent tissue damage due to excessive inflammation. Uropathogens in general, and uropathogenic Escherichia coli (UPEC) in particular, have evolved a diverse range of virulence mechanisms to avoid detection and destruction by the mucosal immune system of the urinary tract. Research towards a vaccine active against UPEC continues but has yet to be successful. Orally administered immunomodulatory bacterial lysates both stimulate and modulate the immune response in the urinary tract via the integrated mucosal immune system. The 2018 European Association of Urology (EAU) guidelines on treating acute uncomplicated cystitis recommend aiming for rapid resolution of symptoms, reduction of morbidity, and prophylaxis against reinfection. Recommended short-term antibiotic therapy has the advantage of good compliance, low cost, few adverse events, and low impact on bacterial flora. Antibiotic treatment of asymptomatic bacteriuria is only indicated during pregnancy and before invasive interventions. For recurrent infection, prophylaxis using behavioral modification and counseling should be employed first, then nonantibiotic prophylaxis, and, finally, low-dose continuous or postcoital antibiotic prophylaxis. The 2018 EAU guidelines give a strong recommendation for the oral bacterial lysate immunomodulator OM-89. All other nonantibiotic prophylactic strategies require more data, except for topical estrogen for postmenopausal women. For last-resort antibiotic prophylaxis, nitrofurantoin or fosfomycin trometamol are recommended. Guidelines for Latin America are currently being drafted, taking into account the unique ethnicity, availability of medicines, prevalence of antibiotic resistance, and healthcare practices found throughout the region. SAGE Publications 2019-05-02 /pmc/articles/PMC6502980/ /pubmed/31105773 http://dx.doi.org/10.1177/1756287218824089 Text en © The Author(s), 2019 http://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Supplement 11 Issue 1S
Ortega Martell, José Antonio
Naber, Kurt G.
Milhem Haddad, Jorge
Tirán Saucedo, José
Domínguez Burgos, Jesús Alfonso
Prevention of recurrent urinary tract infections: bridging the gap between clinical practice and guidelines in Latin America
title Prevention of recurrent urinary tract infections: bridging the gap between clinical practice and guidelines in Latin America
title_full Prevention of recurrent urinary tract infections: bridging the gap between clinical practice and guidelines in Latin America
title_fullStr Prevention of recurrent urinary tract infections: bridging the gap between clinical practice and guidelines in Latin America
title_full_unstemmed Prevention of recurrent urinary tract infections: bridging the gap between clinical practice and guidelines in Latin America
title_short Prevention of recurrent urinary tract infections: bridging the gap between clinical practice and guidelines in Latin America
title_sort prevention of recurrent urinary tract infections: bridging the gap between clinical practice and guidelines in latin america
topic Supplement 11 Issue 1S
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502980/
https://www.ncbi.nlm.nih.gov/pubmed/31105773
http://dx.doi.org/10.1177/1756287218824089
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