This study reviewed 908 female patients with recurrent urinary tract infections (rUTIs), analyzed antimicrobial prophylaxis usage patterns, recurrence rates, and tolerability, highlighting differences in prophylaxis strategy selection and effectiveness between premenopausal and postmenopausal women.
Literature Overview
This article, 'Antimicrobial Prophylaxis for Recurrent Urinary Tract Infections in Premenopausal and Postmenopausal Women: A Retrospective Observational Study from an Outpatient Clinic in a Tertiary University Hospital', published in the journal Antibiotics, summarizes the application patterns, recurrence rates, comparative efficacy of different antibiotic regimens, and adverse reactions associated with antimicrobial prophylaxis for recurrent urinary tract infections (rUTIs) in women. rUTIs significantly impact women's quality of life, making antimicrobial prophylaxis a critical intervention strategy.
Background Knowledge
Recurrent urinary tract infections (rUTIs) are common among women, with approximately 20-40% experiencing recurrence after the initial infection. rUTIs are defined as two episodes within six months or three episodes within one year, confirmed by urine culture. Physiological differences between premenopausal and postmenopausal women lead to variations in infection risk and prophylaxis strategies. Postmenopausal women are more susceptible to pathogen colonization due to estrogen deficiency and altered vaginal microbiota, whereas premenopausal women are more likely to be affected by risk factors such as sexual activity and contraceptive methods. Common causative pathogens include Escherichia coli (E. coli), Enterococcus faecalis (E. faecalis), and ESBL-producing E. coli. Current antimicrobial prophylaxis strategies include continuous low-dose, postcoital prophylaxis, and self-treatment, with nitrofurantoin and fosfomycin being commonly used. However, the response to antibiotics and the incidence of adverse events between premenopausal and postmenopausal women remain incompletely understood. This study provides real-world data to guide personalized treatment approaches.
Research Methods and Experiments
This single-center retrospective observational study analyzed medical records from 908 female patients (663 postmenopausal and 245 premenopausal) treated between January 2022 and December 2025 in an outpatient clinic at a tertiary university hospital. Patients were categorized into different prophylaxis groups (continuous low-dose, combined non-antibiotic, combined intermittent antibiotic), and recurrence rates (per 100 patient-months) and adverse events were analyzed. For rUTIs caused by E. coli, E. faecalis, or E. coli ESBL, weighted and exact matching analyses were conducted to compare the prophylactic efficacy of nitrofurantoin versus other antibiotics, primarily fosfomycin.
Key Conclusions and Perspectives
Research Significance and Prospects
This study provides real-world data for clinical practice regarding antimicrobial prophylaxis strategies for rUTIs, supporting the superiority of nitrofurantoin for specific pathogens (E. coli, E. faecalis, E. coli ESBL), particularly in postmenopausal women. It also highlights the need for personalized prophylaxis strategies and differences in recurrence and adverse events between the two groups, suggesting that future studies should assess patient characteristics more precisely to develop optimal prophylaxis plans.
Conclusion
This study systematically reviewed the real-world application of nitrofurantoin compared to other antibiotics for preventing recurrent urinary tract infections in women. It found that nitrofurantoin was associated with lower recurrence rates in both premenopausal and postmenopausal women, particularly for infections caused by common pathogens such as E. coli, E. faecalis, and E. coli ESBL. Additionally, the study emphasized the need for personalized antimicrobial prophylaxis and identified differences in recurrence patterns and adverse events between the two groups. These findings provide clinicians with more precise guidance for antibiotic selection and highlight the importance of monitoring adverse reactions, especially in premenopausal women. Future studies should further explore the long-term efficacy and risk of antibiotic resistance associated with different prophylaxis strategies in specific patient populations.
