Intervention Review

Oestrogens for preventing recurrent urinary tract infection in postmenopausal women

  1. Carla Perrotta1,*,
  2. Mireya Aznar2,
  3. Raul Mejia2,
  4. Xavier Albert3,
  5. Cheen Werne Ng4

Editorial Group: Cochrane Renal Group

Published Online: 23 APR 2008

Assessed as up-to-date: 30 JAN 2008

DOI: 10.1002/14651858.CD005131.pub2


How to Cite

Perrotta C, Aznar M, Mejia R, Albert X, Ng CW. Oestrogens for preventing recurrent urinary tract infection in postmenopausal women. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD005131. DOI: 10.1002/14651858.CD005131.pub2.

Author Information

  1. 1

    UCD School of Public Health and Population Sciences, Woodview House, Dublin, Ireland

  2. 2

    Hospital de Clínicas, Universidad de Buenos Aires, Programa de Medicina Interna General (PMIG), Ciudad de Buenos Aires, Argentina

  3. 3

    Valencian Agency of Health, Health Center of Montcada. Department 6, Valencia, Spain

  4. 4

    Penang Medical College, School of Medicine, Penang, Malaysia

*Carla Perrotta, Woodview House, UCD School of Public Health and Population Sciences, Belfield, Dublin, 4, Ireland. carla.perrotta@ucd.ie . carlaperrotta@yahoo.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 APR 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Recurrent urinary tract infection (RUTI) is defined as three episodes of urinary tract infection (UTI) in the previous 12 months or two episodes in the last six months. The main factors associated with RUTI in postmenopausal women are vesical prolapse, cystocoele, post-voidal residue and urinary incontinence, all associated with a decrease in oestrogen. The use of oestrogens to prevent RUTI has been proposed.

Objectives

To estimate the efficacy and safety of oral or vaginal oestrogens for preventing RUTI in postmenopausal women.

Search methods

We searched the Cochrane Renal Group's specialised register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (from 1950), EMBASE (from 1980), reference lists of articles without language restriction.
Date of last search: February 2007.

Selection criteria

Randomised controlled trials (RCTs) in which postmenopausal women (more than 12 months since last menstrual period) diagnosed with RUTI received any type of oestrogen (oral , vaginal) versus placebo or any other intervention were included.

Data collection and analysis

Authors extracted data and assessed quality. Statistical analyses were performed using the random effects model and the results expressed as risk ratios (RR) for dichotomous outcomes or mean difference (MD) for continuous data with 95% confidence intervals (CI).

Main results

Nine studies (3345 women) were included. Oral oestrogens did not reduce UTI compared to placebo (4 studies, 2798 women: RR 1.08, 95% CI 0.88 to 1.33). Vaginal oestrogens versus placebo reduced the number of women with UTIs in two small studies using different application methods. The RR for one was 0.25 (95% CI 0.13 to 0.50) and 0.64 (95% CI 0.47 to 0.86) in the second. Two studies compared oral antibiotics versus vaginal oestrogens (cream (1), pessaries (1)). There was very significant heterogeneity and the results could not be pooled. Vaginal cream reduced the proportion of UTIs compared to antibiotics in one study and in the second study antibiotics were superior to vaginal pessaries. Adverse events for vaginal oestrogens were breast tenderness, vaginal bleeding or spotting, nonphysiologic discharge, vaginal irritation, burning and itching.

Authors' conclusions

Based on only two studies comparing vaginal oestrogens to placebo, vaginal oestrogens reduced the number of UTIs in postmenopausal women with RUTI, however this varied according to the type of oestrogen used and the treatment duration.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Oestrogens for preventing recurrent urinary tract infection in postmenopausal women

Recurrent urinary tract infection (RUTI) is defined as three episodes of urinary tract infection (UTI) in the previous 12 months or two episodes in the last six months. In postmenopausal women the prevalence rate for having one episode of UTI in a given year varies from 8% to 10%. This increased risk is associated with a decrease in oestrogen levels. The use of oestrogens (orally or vaginally) has been proposed as a preventive strategy. This review identified nine studies (3345 women) treated with oestrogens versus placebo, no treatment or antibiotics. Vaginal oestrogens reduced the number of UTIs when compared to placebo. All studies reported adverse events for the oestrogen treatment groups. These included breast tenderness, vaginal bleeding or spotting, vaginal discharge, vaginal irritation, burning and itching.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

雌激素用於預防停經後婦女之反覆性泌尿道感染

反覆性泌尿道感染的定義是指於12個月內發生過三次泌尿道感染或是在六個月中有兩次泌尿道感染。而停經後婦女發生反覆性泌尿道感染的危險因子包括膀胱脫垂、膀胱突出症、尿失禁、殘餘尿量過多。這些都和雌激素減少有關。因此假設可用雌激素預防反覆性泌尿道感染。

目標

評估停經後婦女使用口服或陰道塞劑之雌激素對於預防反覆性泌尿道感染的效果及安全性

搜尋策略

我們搜尋了Cochrane Renal Group specilised register, Cochrane Central Register of Controlled Trials, Mediline, EMBASE, 參考文獻列出了所有文章,但無語言限制

選擇標準

給予診斷為反覆性泌尿道感染之停經後婦女 (停經超過12個月之婦女) 口服或陰道塞劑之雌激素,和給予安慰劑或其他不同治療方式之隨機控制實驗研究均包括在內

資料收集與分析

統計分析使用隨機效果模式 (random effects model) ,結果以相對危險性 (risk ratio) ,平均差及百分之九十五信賴區間表示

主要結論

共有九個研究(3345位女性病人)。口服雌激素並無法降低泌尿道感染 (RR:1.08,95% CI 0.88 – 1.33) 。陰道塞劑之雌激素在兩個小型研究中,可降低泌尿道感染(第一篇研究之RR:0.25, 95% CI 0.13 – 0.5,第二篇研究之RR:0.64, 95% CI 0.47 – 0.86)。兩篇研究比較口服抗生素及陰道塞劑之雌激素,因為此兩篇研究具有相當明顯的差異性,故不將其研究結果納入。陰道雌激素乳液和抗生素相比,能降低一定比例的泌尿道感染,但在。另一篇研究中,則是抗生素優於vaginal passaries。使用陰道塞劑之雌激素的副作用包括乳房變硬,陰道出血,出現非生理性分泌物,陰道刺激感、燒灼感及發癢

作者結論

根據上述兩個研究陰道雌激素可降低停經後婦女發生反覆性泌尿道感染的機率,然而這會因為雌激素的種類及治療時間長短而有差異

翻譯人

本摘要由馬偕醫院黃筱雯翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

反覆性泌尿道感染的定義是指於12個月內發生過三次泌尿道感染或是在六個月中有兩次泌尿道感染。停經後婦女一年內發生泌尿道感染的機率為8% −10% 。反覆性泌尿道感染和雌激素減少有關。因此使用雌激素可用於預防感染發生。本篇文章回顧九篇研究 (3345位女性病人) ,分別以雌激素、安慰劑或抗生素治療。陰道塞劑之雌激素可降低泌尿道感染。副作用包括乳房變硬,陰道出血,出現非生理性分泌物,陰道刺激感、燒灼感及發癢