Treatment and management

Urinary Tract Infection

Lower UTI

— usually involves taking a three to seven day course of an antibiotic. The exact length of the course will depend on whether you have an increased risk of developing complications.

— Trimethoprim is a widely used antibiotic that is used to treat cases of lower UTI. Side effects of trimethoprim are uncommon and they are usually mild. They include:

- nausea

- vomiting

- skin rash

- itchy skin

— Over-the-counter (OTC) painkillers, such as paracetamol or ibuprofen, can be used to relieve symptoms such as abdominal pain.

Upper UTI

— usually involves taking a seven to fourteen day course of antibiotics. Again, the exact length of the course will depend on your risk of developing complications.

— Antibiotics called co-amoxiclav or ciprofloxacin are usually used, unless you are pregnant, in which case an alternative antibiotic such as amoxicillin, ampicillin, nitrofurantoin, and cephalosporin, cefalexin, which is known to be safe to used during pregnancy, can be used instead.

— These types of antibiotics can cause drowsiness, so while you are taking them you should avoid driving and operating complex or heavy machinery.

— Paracetamol can be used to treat the associated symptoms of an upper UTI. However, you should not use the non-steroidal anti-inflammatory drug (NSAID) type of painkiller, such as ibuprofen or naproxen, because they can increase the risk of developing kidney complications.

You may be admitted to hospital if you have an upper UTI and:

— you are pregnant

— you are over 60 years of age

— you have symptoms of severe vomiting

— you have symptoms of severe pain

— you are dehydrated

— you are unable to pass urine, or the amount of urine you are passing is severely reduced

— you have a blockage in your kidneys, such as a kidney stone

— you have diabetes

— you have been undergoing chemotherapy and/or radiotherapy

— you have a previous history of kidney disease

— you have a previous history of recurring upper UTIs

— you have HIV

— you have sickle-cell anaemia

— you have cancer

— If you are admitted to hospital with an upper UTI, you will probably be attached to a drip so that you can be given fluids to help keep you hydrated. Antibiotics can also be administered through the drip.

— You will be given regular blood and urine tests so that your health can be carefully monitored, and to measure the effectiveness of the antibiotics in fighting off the infection.

— Most people who are admitted to hospital to be treated for an upper UTI respond well to treatment and are able to leave hospital within three to seven days.

Treating reoccurring UTIs

— if you have repeated and reoccurring UTIs, further treatment may be required in order to prevent permanent damage to your urinary tract.

— Take a short course (1 or 2 days) of antibiotics when symptoms appear.

— If it is thought that the recurring UTIs are due to your urethra becoming irritated after sexual intercourse, you may be given antibiotics tablets. You should take a tablet after each time that you have sex, ideally in the first two hours after intercourse.

— If you are using a diaphragm or spermicide-coated condom as your main method of contraception, you may want to consider using another method that does not increase your risk of developing UTIs, such as the contraceptive pill.

— If the recurring UTIs are not thought to be linked to sexual intercourse, you may be given a low dose antibiotic which you take daily.

— A medication called methenamine hippurate is an alternative to taking antibiotics. Methenamine hippurate works by changing the chemical composition of your urine, making it ‘less attractive’ to bacteria.

— Side effects of methenamine hippurate are uncommon and include:

- skin rashes

- itchy skin

- indigestion

— Methenamine hippurate is not as effective as antibiotics in preventing the return of infection. Therefore, it tends to only be used in cases where people are unable or unwilling to take antibiotics.

Doctors suggest some additional steps that a woman can take on her own to avoid an infection:

— Drink plenty of water every day.

— Urinate when you feel the need; don't resist the urge to urinate.

— Wipe from front to back to prevent bacteria around the anus from entering the vagina or urethra.

— Take showers instead of tub baths.

— Cleanse the genital area before sexual intercourse.

— Avoid using feminine hygiene sprays and scented douches, which may irritate the urethra.

Alzheimer’s disease

— For most dementias, no treatment can restore mental function

— However, treating disorders that are worsening dementia sometimes slow mental decline

— For people who have dementia and depression, antidepressants (sertraline, paroxetine) and counselling may help

— Abstaining from alcohol can result in long term improvement

Environmental measures

People with dementia can benefit from an environment that is

— Safe: extra safety measures are usually needed (eg. Reminders such as remember to turn off the stove)

— Familiar: people with dementia usually function best in familiar surroundings

— Stable: establishing a regular routine for bathing, eating, sleeping, and other activities can give people with dementia a sense of stability. Regular contact with the same people can also help

— Low stress activities scheduled on regular basis can help people feel independent and needed by focusing their attention on pleasurable or useful task

— Such activities can reduce depression

— Continued mental activity, including hobbies, interest in current events, and reading should be encouraged

Drugs

— Donepezil, galantamine, rivastigmine, and tacrine increase the levels of the chemical messenger acetylcholine, which may be low in dementia.

— These drugs may improve cognitive function temporarily but they do not slow down the progression of the disease.

— Gingko biloba has been claimedtohave similar effects as drugs described above

— Estrogen and vitamin E may help prevent and slow down progression of disease