2023-10-18 08:07:43
by Arrigo Schieppati
They can be favored by anatomical alterations of the urinary tract or by alterations in bladder function. In most patients, treatment with antibiotics does not confer any real benefit
I have been suffering from Escherichia coli for three years. I visited several doctors and they all prescribed antibiotics. What can I do to feel better? Sometimes I feel depressed and I don’t want to take these drugs for life.
Answered by Arrigo Schieppati, Clinical Research Center for Rare Diseases, Mario Negri Institute, Bergamo (VAI AL FORUM)
The finding of the presence of germs in the urine (especially E. coli), in the absence of disorders such as burning, pain or the urge to frequently run to the bathroom, i.e. the so-called asymptomatic bacteriuria, is not at all rare in women (less frequent in males). To be precise, asymptomatic bacteriuria is defined as the presence of bacteria in the properly collected urine of a patient who does not have symptoms of a urinary tract infection (such as those described above). The incidence is 15%, or even more, in women and men aged between 65 and 80 years and reaches 40-50% after the age of 80. Most patients with asymptomatic bacteriuria never develop symptomatic urinary tract infections and experience no adverse consequences.
Patients without symptoms
In the majority of patients with this condition, treatment with antibiotics does not confer any real benefit, although there are exceptions. For example, a pregnant woman with asymptomatic bacteriuria should be treated with antibiotics. In the same way, it is appropriate to treat patients with asymptomatic bacteriuria who need to undergo invasive urological procedures and patients who have received a renal transplant in the first three months following the transplant. As you can see, these are rather specific conditions: in most cases the treatment is not indicated. However, if the presence of E. coli (or other germs) is associated with symptoms of infection and if the episodes often repeat, we are talking about recurrent urinary tract infections.
Patients with symptoms
These recurrent infections can be favored by anatomical alterations of the urinary tract or by alterations in bladder function and have various other favoring factors, which change in the various age groups. To some extent the therapy can also vary in the different conditions and include – in addition to the treatment of the infection in the acute phase with antibacterial drugs, which can hardly be avoided if the symptoms are marked – the adoption of hygiene measures or behaviors that reduce the risk of infection. There are also long-term prophylaxis protocols with low doses of antibiotics, the use of which is decided on a case-by-case basis, based on a direct evaluation of the person.
October 18, 2023 (modified October 18, 2023 | 08:07)
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