| Popis: |
The S3 guidelines aim to promote the rational use of antimicrobial drugs. The authors did not mention the rational use of local vaginal administration of estriol. This mildly effective metabolite of estradiol has a shorter receptor binding time by a factor of 7 and thus bears neither cancer risks nor thrombosis risks. Urinary tract infections (UTIs) are common after the menopause, and one in four women older than 65 is affected. A notable rise in the prevalence of dysuria, imperative urinary urge, and pollakisuria can biologically be explained with increasing urogenital atrophy and even colpitis senilis as a result of long-term estrogen deficiency. Vaginal pathogens can easily reach the bladder via the urinary meatus. Insufficient urethral closure due to estrogen deficiency is a further contributing factor. The effect is compounded by moderate fluid intake in older women (especially those with urinary incontinence) and thus insufficient flushing by means of bladder voiding. Local vaginal estriol treatment prompts proliferation of the urethral and vesical mucosa (as can be detected on microscopic slides of vaginal epithelia showing cellular structures such as before the menopause, after only a few days. Six out of 10 women are found to have a reappearance of lactobacilli in their vaginal secretions, such as during their fertile years (when given placebo, this rate fell to 0 out of 10) (10). The production of lactic acid in an acidic vaginal milieu protects against pathogens. Estriol as a metabolite of estradiol leads to better vascularization of the urogenital region, but climacteric problems are not eliminated. Estriol with its proliferation promoting effect has preventive benefits in recurrent UTIs after antibiotic treatment. In a randomized double blind study (2), susceptibility to infection was reduced by means of local estriol to 0.5 episodes per year, compared with 5.9 in women of the same age. This benefit for estriol was confirmed in a placebo controlled study (3). One pessary of estriol costs 70 cents (initially it should be administered twice weekly, later once weekly). Risks and side effects have not been seen in 40 years. This is fully consistent with the objective of the UTI guidelines: fewer exposures to antibiotic agents. |
