Scenario: Cranberries & UTIs

Practice Scenarios

Scenario: Cranberries & UTIs

In Practice Scenarios

Sarah James has a prescription for nitrofurantoin and asks to buy some urine testing strips. She asks Parveen what she should do...

“Should I get this prescription dispensed or not?” she asks. “I’ve got that familiar prickly feeling that means I may be getting a kidney infection, but the doctor has told me to not take anything unless I get a positive result with these dipsticks. At the moment, I’m trying to stave it off with cranberry juice because I read in the newspaper that it can help prevent urinary infections taking hold, so should I wait or just start the antibiotics? This will be my third lot in as many months, although I’ve always had trimo-something before.”

Answer

The advice the GP has given Sarah is spot on in this case. Given that Sarah has been prescribed trimethoprim twice in the past couple of months for lower urinary tract infections, nitrofurantoin is a sensible option.

As she only has mild discomfort at the moment, it is worth her holding off starting treatment until either she has had a positive result from her urine sample, or she develops more symptoms indicative of a lower UTI such as urinary frequency and urgency, dysuria, lower abdominal achiness, urine that is cloudy, offensive smelling or contains blood, or non-specific malaise.

The most sensible course of action is for Parveen to sell the urine testing sticks and dispense the prescription so Sarah is able to test her urine and then have the antibiotics on standby if needed.

Should a UTI develop, Sarah should take a urine sample to the GP surgery before she starts treatment in order to try and work out what is causing her recurrent infections.

The BIGGER picture

Cranberry juice and cranberry products have been associated with UTI prevention for many years, which scientists have put down to proanthocyanidins – a component of the fruit known to inhibit bacterial adhesion to cells. However, a 2012 Cochrane review of 24 studies found that cranberry juice and cranberry products did not appear to have a significant benefit in preventing UTIs.

Extend your learning

  • Urine testing strips may seem straightforward to use on first glance, but read the information leaflet that comes with the pack so you are able to advise someone appropriately and answer any questions.
  • Nitrofurantoin has an interaction with a relatively commonly used drug. Find out what it is by looking in the interactions section of the BNF.
  • Urine alkalisation is the self-care step traditionally recommended to relieve UTI symptoms and the premise on which OTC cystitis products exist. Read about the evidence for this approach here
  • A three-day course of antibiotics is sufficient for most women with an uncomplicated lower UTI. Find out when a 5 to 10-day course might be necessary by reading the information here.

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