Dr. Caroline Dowling on re-education regarding recurrent UTI management


"We definitely need women to be able to access care quickly and efficiently. But, putting antibiotics at the forefront is not going to be the answer," says Caroline Dowling, MBBS, MS, FRACS (Urol).

In this video, Caroline Dowling, MBBS, MS, FRACS (Urol), discusses the background and key points from the BJU International research letter “Management of recurrent urinary tract infections: re-education is required.” Dowling is co-director of Medical Student Programs and an adjunct clinical associate professor at Eastern Health Clinical School, Monash University, Melbourne, Australia.


Could you describe the background for this paper?

I'm very motivated to help women in their plight over urinary tract infections. There are so many women who have experienced them; [there's a] 60% risk over a lifetime, and 20% to 40% of them will become recurrent. That's a significant health burden for those women, and they often don't get well served. I think if you go on to any of the social media platforms, you'll find loads of women who are really suffering because they're misunderstood, they're not heard, they've got poor access to care. So I think that's what's really motivated me to do this research.

Please summarize some of the key points as to why re-education is required management of recurrent UTIs.

There's a lot of ineffective antibiotic prescribing. That's not to say that some women don't need antibiotics. But there's a lot of ineffective prescribing. And there's a lot of other non antibiotic treatments that women could be accessing with good success. There was a landmark trial...where they compared trimethoprim to methenamine hippurate, and the methenamine, which we know colloquially as Hiprex, performed really almost as well as the antibiotics. These options need to be front and center for women. Unfortunately, Australia has gone down a path of providing greater access to antibiotics over the counter in pharmacies. I don't think that that's necessarily the answer. We definitely need women to be able to access care quickly and efficiently. But, putting antibiotics at the forefront is not going to be the answer.

What are some next steps in terms of research and clinical practice regarding management of recurrent UTIs?

I think in the research setting, I'm really interested in the immune aspects of recurrent urinary tract infections and urinary tract infection in the first place. I think the vaccines, which have been trialed in North America and Canada and have been used quite widely in Australia and New Zealand, hold great hope. And the theory that women may need to be exposed to some of these pathogens and develop an immune reaction in a controlled way without antibiotics in order to then stave off future infection, I think there are a really fascinating concepts that are much more aligned with trying to help women in the long run manage these very frequent health issues with some more targeted therapy.

This transcription was edited for clarity.

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