UTI And Cranberries
Dec 26, 2016
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
In Pictionary, if you pick me for your team, you will lose. I can't draw. I also have a minor travel mug hoarding problem. I have a mug of some warm beverage near me at work at all times. That also means I have a cupboard at home that kinda explodes with travel mugs. I don't think my kids are related to me some times. Emily is quite artistic and she is who you want on your Pictionary team. The other day, while doing dishes, Eric asked if I wanted him to organize my travel mugs.
Another question that surprised me lately is: do we have to change how we prevent UTI's in care homes? Urinary tract infections are troublesome to patients because they can have uncomfortable symptoms like always feeling like you have to pee, and burning when you do. UTI's can be distressing for nurses and family members because in some cases patient's behavior changes dramatically and suddenly grandma can't remember how to use a spoon to feed herself. Pharmacists worry about antibiotic resistance. Antibiotic resistance is when an antibiotic that used to kill certain bacteria won't kill it anymore. A good way to develop antibiotic resistance is to get the same type of infection over and over again and to treat that infection with the same antibiotic over and over again. Unfortunately, this is exactly what happens with urinary tract infections in nursing homes.
Urinary tract infections are very common in long term care homes, especially in women. To prevent chronic recurrent UTI's we often give women in long term care homes cranberry pills. There is some very interesting science behind cranberries and UTI's. Instead of killing bacteria, something in the cranberry seems to effect how well bacteria can attach to the lining of the urinary tract. If the bacteria can't attach, they can't cause an infection. Since the cranberry doesn't kill the bacteria, it also seems unlikely it can cause antibiotic resistance. So, all women in a care home who get recurrent UTI's should be on cranberries, right? Although the science is intriguing, the question is, do cranberries really help prevent UTI's? Has this idea been tested?
In the past, I would have said the evidence is conflicting, but cranberry pills are unlikely to do any harm. For example, in 2012 Jepson and Craig updated the review of using cranberries for preventing UTI's for the Cochrane Group. Cochrane Reviews are nice because they don't take money from drug companies, and so are relatively unbiased. The Cochrane Review looked at 10 studies containing 1049 people. The best the Cochrane Review could say is cranberries might decrease the number of symptoms of UTI's in women. And as good as Cochrane Reviews are, they are meta-analysis. They are just reading a bunch of other people's studies. A meta-analysis is not as good as a double blinded placebo controlled trial.
Juthani-Mehta et. al. recently published a paper in the Journal of the America Medical Association or JAMA called "Effect of cranberry capsules on bacteriuria plus pyuria among older women in nursing homes." They followed 185 patients who either got cranberry capsules or placebo for 12 months. They found no difference between the placebo group and the cranberry group in number of people in which they found an infection in the urine, white blood cells in the urine, UTI symptoms, hospitalizations, or death.
So, should we take all the women in care homes off of cranberry capsules? Well the evidence seems to have switched from they might help to they probably don't help. So, in general, yes we should start taking people in care homes off of cranberry capsules to prevent UTI's. However, cranberry capsules are not expensive and are unlikely to do any harm. If I run into a family or a care home resident that is absolutely, positively convinced cranberry capsules are the best thing for a particular loved one, I am not going to forbid them from taking it.
Patients and families get understandably stressed when pharmacists and doctors say the treatment we were using doesn't seem to have evidence to support it anymore. I know sometimes that makes us look like we don't know what we are doing. However, I think when we change how we practice do to new information, it is a sign of progress. I don't ride a horse to work. I don't contact my mother with a telegraph. Cars and iPhones have been surprising new things that have made my life better.
Eric did a marvelous job organizing my travel mugs. He took a piece of cardboard to separate the lids from the cups so you could find one of each. And now my mug collection takes up way less space. Eric surprised me with his organizational skills. I certainly have none. And sometimes learning surprising new things is a good thing.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
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