Urinary tract infections or UTIs are a very common, very vexing problem for many people, most of them women. On PodMed this week, Rick and I review the fact that over 1 million, yes, that's right, 1 million hospital admissions occur yearly due to complications of UTIs, often recurrence and persistence. It's probably worth mentioning that female anatomy is largely to blame since the urethra is so short it allows bacteria to reach the bladder without much in the way of a journey. Add to that hormonal fluctuations, sexual activity and even athletics and it's no surprise that UTIs are so troublesome, and women don't age out of the problem. Indeed, undiagnosed UTIs in largely female patients with Alzheimer's disease and other forms of dementia may account for combativeness and a host of other behavioral problems. Wouldn't it be great, then, for a simple grocery store item like cranberry juice or other cranberry products to helpful? Unfortunately, this review in JAMA clearly shows they are not, so it seems legions of women must go back to the cupboard or pharmacy and try again.
This Cochrane review took a look at 24 randomized trials with almost 4500 participants in a range of countries and medical care settings. Study subjects included children, pregnant women, people with a history of recurrent UTIs, a sprinkling of men, and people who required catheterization. Cranberry products, including juice and concentrates, tablets and capsules were compared with placebo, water, or no treatment. Overall, no cranberry product was associated with fewer UTIs, although the products appeared safe. Booo for those who would like to utilize self-administered interventions and become more participatory in their own care, I say.
The authors do offer an observation and a caveat about the findings of this study: it appears that adherence to the protocol was low for use of the cranberry products and the rate of study withdrawal high, so perhaps tolerating a certain amount of discomfort from a UTI precluded study completion and a benefit might have appeared further along. They also reveal that measurement and standardization of the purported active ingredient in cranberry products, called proanthocyanidin, was lacking, and future efforts to study the effect of cranberry products should remedy both.
In the meantime, what can someone who experiences UTIs do? Many preventive strategies use antibiotics to ward off the infection or catch it very early, and professional societies largely endorse this. Severe, recurrent UTIs warrant evaluation by a urologist, ideally one with an interest in this problem.
Other topics this week include two new drugs for diabetes of a novel class of such medications, in NEJM, cognitive dysfunction after ICU stays in the same journal, and hormone replacement therapy follow up from the Women's Health Initiative in JAMA. Until next week, y'all live well.