Topic:Does topical estrogen decrease recurrent UTIs in postmenopausal women?

 Case Scenario:

67 yo female with three episodes of symptomatic lower UTI (frequency, dysuria, urine culture with >10,000 sensitive E. coli) wondering if there is "anything else" we can offer her.

 Clinical Bottom Lines:

1. Topical estrogen decreases UTIs in postmenopausal women with recurrent UTIs.

2. Due to side effects (itching and burning) 28% of treated and 17% of placebo patients dropped out of the study.

 Evidence:

Double-blinded, randomized, placebo-controlled trial of 93 postmenopausal women with a history of recurrent UTIs using placebo vs 0.5 mg Estriol intravaginal cream

1. Estrogen was unmeasurable in the serum after 24 h after topical application

2. Cost of topical estrogen for 6 months treatment:

Cost of 3 days of antimicrobials for 3 episodes of uncomplicated UTI (6 month risk)

R. Raz and W. Stamm. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. NEJM 1993;329:753-6.

 Key Words:

urinary tract infection, estrogen