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CONTINUING PROFESSIONAL DEVELOPMENT
against RUTIs. However, the reviewers of
this second meta-analysis warned that
the findings may not be valid due to
heterogeneity of the studies.
The optimal dosage, dosage form
and duration of cranberry treatment
In postmenopausal women, oestrogen
replacement therapy can restore
atrophic vaginal mucosa, normalise
vaginal flora and lower vaginal pH,
which may prevent RUTIs.
Cochrane review concluded that
vaginal oestrogens (e.g. Vagifem,
Ovestin) may reduce the risk of RUTIs
in postmenopausal women. However,
oral oestrogens do not reduce the risk
It has been proposed that
administration of lactobacillus restores
and maintains normal urogenital flora,
which can prevent RUTIs. Trials have
studied both oral and vaginal
administration of various strains of
lactobacilli, but the overall results are
There is very little data to support the
use of self-care strategies for preventing
RUTIs. However, most guidelines
recommend women follow the
strategies shown in Box 3.
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forgotten drug for preventing recurrent urinary tract
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1. Which ONE of the following
statements about recurrent UTIs is
a) Risk factors for recurrent UTIs are similar
to the risk factors for an initial UTI.
b) Most recurrent UTIs are caused
by spread of bacteria from the
c) Most recurrent UTIs in postmenopausal
women are caused by sexual activity.
d) Recurrent UTIs are usually treated with
2. Which ONE of the following
combinations of signs and symptoms
of an acute UTI in a premenopausal
woman is MOST common?
a) Dysuria, frequent or urgent urination,
b) Fever, chills, dysuria, frequent or urgent
c) Cloudy urine, dysuria, frequent or urgent
d) Cloudy urine, dysuria, fever.
3. Which ONE of the following
statements about prophylaxis of
recurrent UTIs is CORRECT?
a) Hexamine hippurate is only effective if
urine pH <6.
b) The evidence for the efficacy of
cranberry products is strong.
c) Oral oestrogens can reduce the risk of UTIs.
d) Intermittent doses of antibiotics are not
appropriate for prophylaxis of UTIs.
4. Which ONE of the following self-
care strategies can pharmacists
recommend to women for
prevention of recurrent UTI?
a) Empty bladder soon after sex.
b) Wipe back-to-front after defecation.
c) Use spermicide when using condoms.
d) Wear tight-fitting cotton underwear.
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