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EDITORIALS: Dee Mangin and Les Toop Urinary tract infection in primary care BMJ 2007; 334: 597-598 [Full text]

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cranberry juice is worth a try to reduce recurrence rate

oscar,m jolobe   (27 March 2007)

Urinary tract infection in secondary care

Sunku H Guptha, Ankur Gupta   (29 March 2007)

cranberry juice is worth a try to reduce recurrence rate 27 March 2007
oscar,m jolobe, retired geriatrician 1 The Lodge, 842 Wilmslow Road, Didsbury, M20 2RN Send response to journal: Re: cranberry juice is worth a try to reduce recurrence rate	Cranberry juice, although not mentioned in the above commentary(1), might have a role in reducing the recurrence rate of urinary tract infections(UTI's) in primary care(2).In the latter study,which compared cranberry-lingoberry juice to lactobacillus GG drink, the cumulative rate of first recurrence of UTI's during 12 months follow up was significantly lower(p=0.048) in the cranberry-lingoberry group(2).According to one review, the chances of having bacteriuria with pyuria are 42% less in patients treated with cranberry juice than in a control group of patients(3). The major obstacle to the acceptance of cranberry juice as a valid treetment modality is the wide variety products and dosing regimens. However, given the non toxic nature of cranberry juice, there is scope for giving patients the benefit of dosing with liberal amounts of the preparation most acceptable to them, and documenting the subsequent outcome. With this approach, patients have very little to lose, and potentially, much to gain. References (1) Mangin D., Toop L Urinary tract infection in primary care BMJ 2007:334:597-8 (2) Kontiokari T., Sundqvist K., Nuutinen M et al Randomised trial of cranberry-lingoberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women BMJ 2001:322:1-5 (3)Raz R., Chazan B., Dan M Cranberry juice and urinary tract infection Clinical Infectious Diseases 2004:38:1413-9 Competing interests: None declared
Urinary tract infection in secondary care 29 March 2007
Sunku H Guptha, Consultant Physician Edith Cavell Hospital, Peterborough PE3 9GZ, Ankur Gupta Send response to journal: Re: Urinary tract infection in secondary care	McNulty et al findings of lower than expected Trimethoprim resistance in urinary tract infection(UTI) in primary care is likely to be true in secondary care too.[1] There are a number of factors that influence antibiotic choice for empirical treatment of UTI for patients in secondary care and these include the previous prescriptions of antibiotics by General Practitioners before patients admission, the perception that hospital acquired UTIs are likely to be resistant to Trimethoprim or Nitrofurantoin and that catheter related UTI are likely to be secondary to pseudomonas. These perceptions lead to prescription of broad spectrum antibiotics irrespective of patient’s clinical condition and this increases the risk of C.difficile associated diarrhoea especially in the older adults. We conducted an audit of positive urinary cultures in acutely ill medical patients over a period of 2 months to study the most common organisms responsible for UTI and their sensitivities to various antibiotics. We analysed 100 samples and arbitrarily divided mid stream urine(MSU) culture positive samples as community acquired UTI if the urinary sample was sent with in 7 days of admission and hospital acquired UTI if the samples were sent 7 days after admission. We also studied catheter related positive urine cultures(CSU). 65/100 samples grew an organism and the remaining samples were mixed growths with no definite organism. The most common organisms grown were E.coli 70% (21/30) of MSU samples and 40% (14/35) of CSU samples followed by P.aeruginosa 13%(4/30) of MSU samples and 26% (9/35) of CSU samples. All the positive culture samples did not have sensitivities. A summary of the antibiotic sensitivities is shown in the table and it is clear that most secondary care UTIs can be treated with Trimethoprim or Nitrofurantoin and they should remain the first line of empirical antibiotic treatment. We agree with your editorial[2] that empirical first line treatment should be informed by clinical and microbiological data but add that there is no reason to prescribe a broad spectrum antibiotic as first line treatment for UTI either in primary or secondary care and that, such prescriptions should only be made after urine culture and sensitivity results. MSU(<7 days) MSU(>7 days) CSU Trimethoprim 87%(19/22) 33%(5/15) 62%(5/8) Nitrofurantoin 91%(10/11) 100%(13/13) 66%(2/3) Caphelexin 100%(16/16) 100%(14/14) 83%(6/8) Ampicillin 66%(14/21) 27%(4/15) 71%(5/7) Table: Antibiotic sensitivities for positive urine cultures (excluding P.aeruginosa) from hospitalised acute medical patients. (Figures in brackets are proportions)MSU - mid stream urine, CSU - catheter sample of urine References: 1.McNulty CA, Richards J, Livermore DM, Little P, Charlett A, Freeman E, et al. Clinical relevance of laboratory-reported antibiotic resistance in acute uncomplicated urinary tract infection in primary care. J Antimicrob Chemother 2006;58:1000-8. 2.Dee Mangin, Les Toop. Urinary tract infection in primary care BMJ 2007;334:597-598, Competing interests: None declared