product characteristics (SPC) for methenamine, estrogens, trimethoprim and nitrofurantoin. Notably, our study included a large number of nursing homes representing diversity pen barnehage troms in size and function. Of all residents of residents with prophylaxis Residents given prophylaxis for UTIs Agents used for prophylaxis of institutions. However, they were only used by 18 of the residents prescribed prophylaxis in this study. As glomerular filtration rate decline by age, nursing home patients are at risk of a negative risk/benefit balance for the use of nitrofurantoin. Thus, further studies are needed to clarify this prescribing behaviour and to evaluate possible benefits and disadvantages of prophylactic treatments in nursing home residents. Traditionally, cranberries have been used to prevent UTIs, but studies of efficacy have shown conflicting results.
Appropriateness of prophylactic prescribing was evaluated with references to evidence in the literature and current national guidelines. Discussion The main finding of this study is that agents frequently prescribed to prevent UTIs in Norwegian nursing homes lack documented efficacy in the elderly. However, we could not find any studies showing that vitamin C is effective in preventing UTIs in the elderly. The use of methenamine and cranberries were common, but the efficacy of these agents is not well documented. Among residents using prophylactic agents, 74 had one agent prescribed, while 26 were prescribed two, three or four concomitant prophylactic agents, Table. If this is true, prophylaxis should be focused on improving hygiene and providing incontinence materials rather than prescription of the agents found in our study.
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A recent Cochrane review concluded that cranberries could be effective, but that the evidence for the elderly still was inconclusive. In contrast to this, the withdrawal rates due to adverse reactions were the same comparing 500 mg cranberry extract with 100 mg trimethoprim in one study and with trimethoprim-sulfamethoxazole in another study. Current Norwegian guidelines recommend vaginal estrogens to women with recurrent UTIs. Interactions may be a problem in patients with polypharmacy, especially for concentrated cranberry products. One questionnaire concerned the nursing home characteristics and demographics and the second questionnaire concerned the prescription of prophylactic agents for UTIs. Level of care was categorised as rehabilitation, long term somatic or dementia special care units when at least 70 of the beds fell into one of the categories. Appropriateness of the prophylactic prescribing was evaluated with reference to evidence in the literature and current national guidelines. As a consequence of the high frequency of UTIs in nursing homes, several prevention strategies for recurrent UTIs are suggested.