What Is the Main Idea?

Urinary tract infections belong to the most common bacterial infections. They do commonly recur and affect primarily women. Antibiotics have been the main treatment procedure, but repeated use of antibiotics can lead to bacteria becoming resistant to them and is not cost-effective. Bacterial vaccines have been developed and have been shown to be effective in reducing the need for antibiotic treatment. In the open-access article “Cost-Effectiveness of a Sublingual Bacterial Vaccine for the Prophylaxis of Recurrent Urinary Tract Infections” recently published in the journal Urologia Internationalis, the authors go a step further to study the economic benefits of using a specific bacterial vaccine that has shown to be highly effective already.

What Else Can You Learn?

The blog post describes urinary tract infections, the symptoms, and the current treatment. Further, the reason why these infections occur repeatedly in women and ways to prevent them are also explained.

Urinary Tract Infections

Urinary tract infections (UTIs) refer to infections by bacteria of any part of the urinary tract, which includes the urethra, bladder, ureters, and kidneys. When there is no structural abnormality of the urinary tract or if the patient does not have any other disease, the infection is classified as an uncomplicated UTI. The main symptoms of UTI are increased frequency or urgency of urination, burning or pain during urination, pain in the pelvic region, and blood in the urine. Uncomplicated UTI usually affects the urethra and bladder and may not show symptoms of fever, nausea, or vomiting.

Why Do Urinary Tract Infections Recur and Why Do They Affect Women More?

Annually about 150 million people suffer from UTIs. Women are estimated to have a 30 times higher chance of having a UTI compared to men, especially during their sexually active age. About 40–60% of women are expected to get the infection at least once in their lifetime. UTI is considered recurrent if there are more than 2 episodes in 6 months or 3 episodes in 12 months.

Recurrent UTIs are more common in women because they have shorter urethras than men. Hence, bacteria can more easily climb up the organ and cause infection. Also, the vaginal and rectum openings are in proximity to the urethral opening. So, if the vulvar region is not cleaned correctly, “bad” bacteria can pass from other openings to the urinary tract. In postmenopause, the lower estrogen levels cause lower levels of “good” bacteria and vaginal dryness. These, in turn, increase the chance of developing an infection.

Current Treatments and Need for Alternatives

The good news is that in about 20% of cases, the infection goes away on its own, especially with increased hydration. However, if it is persistent, and to avoid the infection from climbing up to the kidneys, the patient will be required to take an antibiotic course. This is the mainline treatment for UTIs. If there are recurrent infections, a low-dose, long-term course of antibiotics, or single courses after sexual activity (if sexual activity is the known cause) may be prescribed.

The problem with the use of antibiotics is that it does not stop infections from recurring. Moreover, for such a prevalent type of infection requiring repeated courses of antibiotics, there is the possibility of the bacteria becoming resistant to these medications. Additionally, with recurring infections, there is a huge burden of cost to the individual and the medical system in treating them.

Vaccine for Urinary Tract Infections

Vaccines are preventive treatments where the body develops the ability to fight the disease without requiring any further treatments in most cases. There are a few bacterial vaccines against UTIs that are being developed and are in various stages of development and trials. In this blog post, we are discussing Uromune®, which is a bacterial vaccine in phase III trial and which has been mainly tested for its ability to reduce recurrent uncomplicated UTIs, especially in women. The vaccine has inactivated whole bacteria of 4 common strains of infection of urinary tracts. This helps cover most infections. The vaccine is not administered as an injection but instead as a flavored spray in the mouth over a period of 3 months.

Multiple studies have been conducted in different countries to test the effectiveness of the vaccine. Based on these studies, the vaccine has been shown to be between 35 and 90% effective in preventing recurrent UTIs which were followed up for 1–2 years. These results are from studies that included only women or some that included also men, children, and old people with other comorbidities. In contrast, there is almost no chance of preventing UTIs with the use of antibiotics as the treatment procedure. The vaccine has also shown to be highly safe with mostly only minor side effects being reported. Most importantly, adherence rates to the continuous use of the spray for 3 months were high.

Economic Advantages of Using Bacterial Vaccines

Considering UTIs are mostly not fatal and can be treated with antibiotics, the recent open-access article “Cost-Effectiveness of a Sublingual Bacterial Vaccine for the Prophylaxis of Recurrent Urinary Tract Infections” studied whether the use of vaccination for them has economic benefits. According to the study, prior to administering the bacterial vaccination, the annual cost per patient suffering from recurrent UTIs was approximately 1,000 EUR. However, after administering the vaccination, the annual cost was reduced to approximately 500 EUR (excluding the one-time vaccination cost of around 172 EUR/treatment). The study included costs from routine laboratory tests, ultrasounds, doctor’s visits, emergency room admissions, and hospitalizations. Therefore, even including the cost of the vaccination, there is a considerable saving to healthcare costs when using the vaccine.

What Can Patients with Recurrent Urinary Tract Infection Do?

Firstly, in many cases, the infection can be prevented by hydration, emptying the bladder fully and regularly, and wiping the genital region from front to back. If the UTI is painful, affects the quality of life, and keeps recurring, it is important to consult the doctor to get it checked and to avoid the infection from spreading. If being administered an antibiotic course, the patient must ensure to complete the full course of the medication for it to be effective and to prevent antibiotic-resistant bacteria from growing. Finally, the new bacterial vaccines against UTIs which can help prevent recurrent infections and which also have cost benefits might be considered.

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