Background Recurrent urinary tract infections are a problemfor many postmenopausal women. Estrogen replacement restoresatrophic mucosa, lowers vaginal pH, and may prevent urinarytract infections.
Methods We enrolled 93 postmenopausal women with a history ofrecurrent urinary tract infections in a randomized, double-blind,placebo-controlled trial of a topically applied intravaginalestriol cream. Midstream urine cultures were obtained at enrollment,monthly for eight months, and whenever urinary symptoms occurred.Vaginal cultures and pH measurements were obtained at entryand after one and eight months. The women were assigned to receiveeither estriol (n = 50) or placebo (n = 43), both administeredintravaginally; 36 and 24, respectively, completed the eightmonths of follow-up.
Results The incidence of urinary tract infection in the groupgiven estriol was significantly reduced as compared with thatin the group given placebo (0.5 vs. 5.9 episodes per patient-year,P<0.001). Survival analysis showed that more of the womenin the estriol group than in the placebo group remained freeof urinary tract infection (P<0.001). Lactobacilli were absentin all vaginal cultures before treatment and reappeared afterone month in 22 of 36 estriol-treated women (61 percent) butin none of the 24 placebo recipients (P<0.001). With estriolthe mean vaginal pH declined from 5.5 to 3.8 (P<0.001), whereasthere was no significant change with placebo. The rate of vaginalcolonization with Enterobacteriaceae fell from 67 percent to31 percent in estriol recipients but was virtually unchanged(from 67 to 63 percent) in the placebo recipients (P<0.005).Side effects were minor, but caused 10 estriol recipients (28percent) and 4 placebo recipients (17 percent) to discontinuetreatment.
Conclusions The intravaginal administration of estriol preventsrecurrent urinary tract infections in postmenopausal women,probably by modifying the vaginal flora.
Source Information
From the Infectious Disease Unit, Central Emek Hospital, and the Technion Faculty of Medicine, Haifa, Israel (R.R.), and the Department of Medicine, University of Washington, Seattle (W.E.S.).
Address reprint requests to Dr. Raz at the Infectious Disease Unit, Central Emek Hospital, Afula, 18101 Israel.
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