Recurrent Uncomplicated Urinary Tract Infections – The Place of Immuno-prophylaxis

James Gilbart
European Urological Review, 2011;6(2):114-119
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Abstract

Recurrent uncomplicated urinary tract infections (UTIs), especially cystitis in women, are very common and impose a substantial disease burden in populations worldwide. While acute episodes can be successfully treated with antibiotics, they often fail to prevent recurrence; pathogenic bacteria re-establish and symptoms reappear within a few months. The intractable nature of some UTIs and the alarming development of antibiotic resistance have stimulated efforts to identify non-antibiotic and more effective treatments that provide a better solution. Such alternatives are diverse and include probiotics, cranberry juice and hormonal therapies, but these have shown limited efficacy. Another approach, immuno-active prophylaxis with Uro-Vaxom®, has been more widely studied and its use is supported by an extensive body of clinical evidence. In this treatment, patients receive oral capsules containing an extract from multiple pathogenic Escherichia coli strains (Uro-Vaxom). Mechanism of action studies show that Uro-Vaxom effectively stimulates both innate and adaptive immune responses against UTI pathogens. In a series of large clinical trials and in regular clinical use, Uro-Vaxom has proven to be a highly effective and well-tolerated approach to treating recurrent UTIs. In a larger example of these trials, Uro-Vaxom reduced the frequency of UTI recurrences by 34%, the duration of recurrences by 49% and significantly reduced the consumption of antibiotics compared with placebo. These positive results led the European Association of Urology guidelines to recommend its use for prevention of recurrent UTI.

Support: The publication of this article was supported by OM Pharma.
Keywords
Recurrent urinary tract infection, immunoprophylaxis, immunostimulant treatment, guidelines, clinical evidence, mode of action
Disclosure James Gilbart is an employee of Touch Briefings.
Received: June 07, 2011 Accepted June 14, 2011
The Guidelines Offer More than One Option to Prevent Recurrent Urinary Tract Infections

Despite the availability of antibiotics and improved hygiene practices, recurrent urinary tract infections (rUTIs) remain common and a significant cause of morbidity in populations throughout the world. These are believed to be the most common human bacterial infection and affect various groups including young children, the elderly, patients with spinal cord injuries, multiple sclerosis or with catheters, but are most common among otherwise healthy adult women. In sexually active women, intercourse is the trigger for 75–90 % of UTIs.1–3 Nearly one in three women has had a UTI by the age of 24,4 almost half of them will subsequently experience another episode and 20–30 % will have rUTIs, defined as at least two acute episodes per six months or at least three per year. In the US, UTIs account for almost seven million doctor’s office visits and 100,000 hospitalisations per year,5 and consequently expend considerable medical resources.

Various bacterial species cause UTIs but the majority are caused by pathogenic strains of Escherichia coli. This was emphasised by the Antimicrobial Resistance Epidemiological Survey in Cystitis (ARESC) study, which included 4,264 patients at 68 European and Brazilian treatment centres. The results showed that 76.7 % of UTIs were caused by E. coli, the remainder being caused by various Gram-negative species such as Klebsiella pneumoniae, Enterobacter faecalis and Proteus mirabilis and some Gram-positive bacterial species such as Staphylococcus saprophyticus (see Figure 1).6 Similar proportions of bacterial pathogens have been shown in other studies on cystitis.7–9

In uncomplicated acute cystitis, short-term antibiotic therapy can provide rapid resolution of symptoms with good safety and tolerability and low cost with a generally low impact on host flora. However, the number of suitable antibiotics is limited due to growing problems of bacterial resistance, compliance and adverse events. In the ARESC study, pathogenic E. coli strains isolated from female patients with uncomplicated cystitis were >90 % susceptible to fosfomycin, mecillinam, and nitrofuratoin in all countries, with varying susceptibility to ciprofloxacin between 86 and 98 % depending on the country, and with susceptibility to cotrimoxazole and ampicillin <80 % across Europe and Brazil (see Table 1).6

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