Only Spanish version is available.

Introducción
La infección del tracto urinario es una patología frecuente, con un alto riesgo de recurrencia, por lo que representa un importan-te motivo de consulta. Dentro de la población más afectada se encuentran las mujeres postmenopáusicas debido a la caída de los niveles de estrógenos, tanto locales como sistémicos, perdiéndose la barrera protectora de la vía urinaria contra agentes patógenos. Entre las variadas medidas que potencialmente disminuirían el riesgo de infección urinaria se ha planteado el uso de estrógenos, sin embargo, no está claro si realmente son efectivos.

Métodos
Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud a nivel mundial, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis, preparamos tablas de resumen de los resultados utilizando el método GRADE.

Resultados y conclusiones
Identificamos seis revisiones sistemáticas que en conjunto incluyen siete estudios primarios, de los cuales, cuatro son ensayos aleatorizados. Concluimos que no está claro si los estrógenos orales disminuyen el riesgo de desarrollar infección del tracto urinario sintomática, porque la certeza de la evidencia es muy baja.

Authors: Viviana Castro[1,2], Juan Pablo Canales[1,2], Gabriel Rada[2,3,4]

Affiliation:
[1] Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
[2] Proyecto Epistemonikos, Santiago, Chile
[3] Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
[4] Centro Evidencia UC, Pontificia Universidad Católica de Chile, Santiago, Chile

E-mail: radagabriel@gmail.com

Author address:
[1] Centro Evidencia UC
Pontificia Universidad Católica de Chile
Diagonal Paraguay 476
Santiago
Chile

Citation: Castro V, Canales JP, Rada G. Are oral oestrogens effective in preventing urinary tract infection in postmenopausal woman. Medwave 2020;20(05):e7914 doi: 10.5867/medwave.2020.05.7914

Submission date: 23/11/2017

Acceptance date: 20/12/2017

Publication date: 18/6/2020

Origin: This article is a product of the Evidence Synthesis Project of Epistemonikos Fundation, in collaboration with Medwave for its publication

Type of review: Non-blinded peer review by members of the methodological team of Epistemonikos Evidence Synthesis Project

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1. Perrotta C, Aznar M, Mejia R, Albert X, Ng CW. Oestrogens for preventing recurrent urinary tract infection in postmenopausal women. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD005131. | CrossRef | PubMed |
2. Beerepoot MA, Geerlings SE, van Haarst EP, van Charante NM, ter Riet G. Nonantibiotic prophylaxis for recurrent urinary tract infections: a systematic review and meta-analysis of randomized controlled trials. J Urol. 2013 Dec;190(6):1981-9. | CrossRef | PubMed |
3. Eells SJ, Bharadwa K, McKinnell JA, Miller LG. Recurrent urinary tract infections among women: comparative effectiveness of 5 prevention and management strategies using a Markov chain Monte Carlo model. Clin Infect Dis. 2014 Jan;58(2):147-60. | CrossRef | PubMed | PMC |
4. Cardozo L, Lose G, McClish D, Versi E, de Koning Gans H. A systematic review of estrogens for recurrent urinary tract infections: third report of the hormones and urogenital therapy (HUT) committee. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(1):15-20 | PubMed |
5. Dueñas-Garcia OF, Sullivan G, Hall CD, Flynn MK, O'Dell K. Pharmacological Agents to Decrease New Episodes of Recurrent Lower Urinary Tract Infections in Postmenopausal Women. A Systematic Review. Female Pelvic Med Reconstr Surg. 2016 Mar-Apr;22(2):63-9. | CrossRef | PubMed |
6. Leckie KJ. What is the evidence for the role of oestrogen in the prevention of recurrent urinary tract infections in postmenopausal women? An evidence-based review. Journal of Clinical erontology and Geriatrics 2010 December 2010;1(2):31-35.
7. Cardozo L, Benness C, Abbott D. Low dose oestrogen prophylaxis for recurrent urinary tract infections in elderly women. Br J Obstet Gynaecol. 1998 Apr;105(4):403-7. | PubMed |
8. Kirkengen AL, Andersen P, Gjersøe E, Johannessen GR, Johnsen N, Bodd E. Oestriol in the prophylactic treatment of recurrent urinary tract infections in postmenopausal women. Scand J Prim Health Care. 1992 Jun;10(2):139-42. | PubMed |
9. Brown JS, Vittinghoff E, Kanaya AM, Agarwal SK, Hulley S, Foxman B; Heart and Estrogen/Progestin Replacement Study Research Group. Urinary tract infections in postmenopausal women: effect of hormone therapy and risk factors. Obstet Gynecol. 2001 Dec;98(6):1045-52. | PubMed |
10. Ouslander JG, Greendale GA, Uman G, Lee C, Paul W, Schnelle J. Effects of oral estrogen and progestin on the lower urinary tract among female nursing home residents. J Am Geriatr Soc. 2001 Jun;49(6):803-7. | PubMed |
11. Brandberg A, Mellström D, Samsioe G. Low dose oral estriol treatment in elderly women with urogenital infections. Acta Obstet Gynecol Scand Suppl. 1987;140:33-8. | PubMed |
12. Privette M, Cade R, Peterson J, Mars D. Prevention of recurrent urinary tract infections in postmenopausal women. Nephron. 1988;50(1):24-7. | PubMed |
13. Oliviera SA, Klein RA, Reed JI, Cirillo PA, Christor PJ, Walker AM. Estrogen replacement therapy and urinary tract infections in postmenopausal women aged 45–59. Menopause 1998;5:4–8.
14. National Collaborating Centre for Chronic Conditions (UK). Urinary tract infections in adults. London: Royal College of Physicians (UK); 2015.

Perrotta C, Aznar M, Mejia R, Albert X, Ng CW. Oestrogens for preventing recurrent urinary tract infection in postmenopausal women. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD005131. | CrossRef | PubMed |

Beerepoot MA, Geerlings SE, van Haarst EP, van Charante NM, ter Riet G. Nonantibiotic prophylaxis for recurrent urinary tract infections: a systematic review and meta-analysis of randomized controlled trials. J Urol. 2013 Dec;190(6):1981-9. | CrossRef | PubMed |

Eells SJ, Bharadwa K, McKinnell JA, Miller LG. Recurrent urinary tract infections among women: comparative effectiveness of 5 prevention and management strategies using a Markov chain Monte Carlo model. Clin Infect Dis. 2014 Jan;58(2):147-60. | CrossRef | PubMed | PMC |

Cardozo L, Lose G, McClish D, Versi E, de Koning Gans H. A systematic review of estrogens for recurrent urinary tract infections: third report of the hormones and urogenital therapy (HUT) committee. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(1):15-20 | PubMed |

Dueñas-Garcia OF, Sullivan G, Hall CD, Flynn MK, O'Dell K. Pharmacological Agents to Decrease New Episodes of Recurrent Lower Urinary Tract Infections in Postmenopausal Women. A Systematic Review. Female Pelvic Med Reconstr Surg. 2016 Mar-Apr;22(2):63-9. | CrossRef | PubMed |

Leckie KJ. What is the evidence for the role of oestrogen in the prevention of recurrent urinary tract infections in postmenopausal women? An evidence-based review. Journal of Clinical erontology and Geriatrics 2010 December 2010;1(2):31-35.

Cardozo L, Benness C, Abbott D. Low dose oestrogen prophylaxis for recurrent urinary tract infections in elderly women. Br J Obstet Gynaecol. 1998 Apr;105(4):403-7. | PubMed |

Kirkengen AL, Andersen P, Gjersøe E, Johannessen GR, Johnsen N, Bodd E. Oestriol in the prophylactic treatment of recurrent urinary tract infections in postmenopausal women. Scand J Prim Health Care. 1992 Jun;10(2):139-42. | PubMed |

Brown JS, Vittinghoff E, Kanaya AM, Agarwal SK, Hulley S, Foxman B; Heart and Estrogen/Progestin Replacement Study Research Group. Urinary tract infections in postmenopausal women: effect of hormone therapy and risk factors. Obstet Gynecol. 2001 Dec;98(6):1045-52. | PubMed |

Ouslander JG, Greendale GA, Uman G, Lee C, Paul W, Schnelle J. Effects of oral estrogen and progestin on the lower urinary tract among female nursing home residents. J Am Geriatr Soc. 2001 Jun;49(6):803-7. | PubMed |

Brandberg A, Mellström D, Samsioe G. Low dose oral estriol treatment in elderly women with urogenital infections. Acta Obstet Gynecol Scand Suppl. 1987;140:33-8. | PubMed |

Privette M, Cade R, Peterson J, Mars D. Prevention of recurrent urinary tract infections in postmenopausal women. Nephron. 1988;50(1):24-7. | PubMed |

Oliviera SA, Klein RA, Reed JI, Cirillo PA, Christor PJ, Walker AM. Estrogen replacement therapy and urinary tract infections in postmenopausal women aged 45–59. Menopause 1998;5:4–8.

National Collaborating Centre for Chronic Conditions (UK). Urinary tract infections in adults. London: Royal College of Physicians (UK); 2015.