Jo-Ann Caroll Dacawi, Maria Sheila Leynes, Lolita B. Micu, Mary-Lynne Due, Dinna Cruz,
Marie Antoinette Lontok Related Institution
Journal Article, Original
Philippine Journal of Internal Medicine
Date of Publication
BACKGROUND: Urinary tract infection (UTI) is one of the most common bacterial infections. At least 7 million women seek treatment for recurrent symptoms of UTI per year. 10-15 percent of women 60 years old and older have recurrent UTI. The most important factor appears to be estrogen depletion. Hence, the use of intravaginal estrogen.
OBJECTIVES: The objective of this meta-analysis is to determine the efficacy of intravaginal estrogen replacement therapy on preventing recurrent urinary tract infection in postmenopausal women.
SEARCH STRATEGY: Selection criteria. The inclusion criteria used in this review are: originally published articles that were randomized controlled trials, peer reviewed and represent a parallel design having postmenopausal women with confirmed history of recurrent UTI as subjects and used intravaginal estrogen as a treatment arm.
TYPES OF OUTCOME MEASURES: The outcome of therapy was UTI confirmed by at least two of the following criteria: patient symptoms, physician report and microbiological techniques (cytological report, culture). The relative risk reduction, absolute risk reduction and NNT were determined.
DATA COLLECTION AND ANALYSIS: The search was restricted to studies conducted on human subjects and classified as randomized controlled trials in the MED LINE database and Cochrane Renal Group Library. Eleven trials were considered for the meta-analysis. Only five trials met these criteria and were included In the meta-analysis.
MAIN RESULTS: There was a total of 402 subjects. Recurrent UTI was noted at 51.5 percent of estrogen treated population, and 70 percent of the control group. There was a 26.4 percent relative risk reduction and 18.5 percent absolute risk reduction. The number needed to treat was computed to be 5 (p-0.014).
REVIEWERS' CONCLUSIONS: This meta-analysis, based on the valid studies reviewed, showed significant difference as to using estrogen in decreasing frequency of recurrent UTI in postmenopausal women.
1. Eriksen, B C. A Randomized, open, parallel-group study on the preventive effect of an estradiol releasing vaginal ring (Estring) on recurrent urinary tract infections in postmenopausal women.
American Journal Obstetrics and Gynecology 180(5): 1999
2. Kjaergaad, B , Knudsen, W S, Barlebo, J B. Treatment with low-dose vaginal estradiol in post-menopausal women. A Double-blind controlled trial
Ugeskr for Laeger 152(10): 1990
3. Raz, Raul , Stamm, Walter . A Controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections.
The New England Journal of Medicine 329(11): September 1993
4. Raz, R , Colodner, R , Rohana, Y , Battino, S , Rottensterich, E , Wasser, I , Stamm, W . Effectiveness of estriol-containing vaginal pessaries and nitrofurantoin macrocrystal therapy in the prevention of recurrent urinary tract infection in postmenopausal women
Clinical Infectious Diseases 38(11): 2003
5. Xu, R , Wu, Y , Hu, Y . Prevention and treatment of recurrent urinary system infection with estrogen cream in postmenopausal women
Zhonghua Fu Chua Ke Za Zhi 36(9): 2001
6. Cardozo, L , Lose, G , McClish, D , Versi, E , de Koning Gans, H . A systematic review of estrogens for recurrent urinary tract infections: Third report of the horones and urogenital theraphy (HUT) Committee.
International Urogynecologic Journal of the Pelvic Floor Dysfunction 12(1): 2001
7. Corodzo, D , Wise, G , Benness, L . Vaginal estradiol for the treatment of lower urinary tract symptoms in postmenopausal women: A Double -blinded placebo-controlled study
Journal of Obstetrics and Gynecology 21(4): 2001
8. D, W , Godunov, B N, Gvozdev, Miu . Long-term use of ovestin by postmenopausal 2003. 1-46.
9. Lose, G , Englev, E . Oestradiol-releasing vaginal ring versus oestriol vaginal pessarie in the treatment of bothersome lower urinary tract symptoms
British journal of Obstetrics and Gynecology 107(8): 2000
10. Oliveria, S A, Klein, R A, Reed, J I, Cirilo, P A, Christos, P J, Walker, A M. Estrogen replacement therapy and urinary tract infections in postmenopausal women aged 45 - 89
Menopause 5(1): 1998
11. Schmidbauer, C P. Vaginal estriol administration in treatment of postmenopausal urinary incontinence
Urologische Abteilung Allgemeine Oliklinik der Stadt Wien 31(6): November 1992
12. Childs, S . Microbiology and epidemiology in recurrent lower urinary tract infections
Infectious Urology 11(3): 1998
13. Ellis, A , Verma, S . Quality of life in women with urinary tract infections: Is benign disease a misnomer?
Journal of American Board Family Practice 13(6): 2000
14. Fanti, J , Cardozo, L , McClish, D . Estrogen therapy in the management of urinary incontinence postmenopausal women: A Meta-analysis
Obstetrics and Gynecology 83, 12, 1994
15. Nicolle, L . Epidemiology of urinary tract infection
Infectious Medicine 18(13):
16. ODonnel, J , Gelone, S , Abrutyn, E . Selecting drug regimens for urinary tract infections: Current recommendation
Infectious Medicine 19(1): 2002
17. Parsons, A , Merritt, D , Rosen, A , Heath, H , Siddhantin, S , Plouffe, L . Effect of raloxifene on the response to conjugated estrogen vaginal cream or nonhormonal moisturizers in the postmenopausal vaginal atrophy
The American College of Obstetricians and Gynecologists 101(2): 2003
18. Wilhite, L . Urogenital atrophy: Prevention and treatment
Pharmacotherapy 21(4): 2001