Aim:

The aim of this evidence-based review is to assess the efficacy of topical estrogens in the prevention of recurrent urinary tract infections (UTI) in postmenopause women.

Data source:

MEDLINE, National Guideline Clearinghouse, Guidelines Finder, Canadian Medical Association Practice Guidelines, Cochrane Library, DARE (Database of Abstracts of Reviews of Effects) and Bandolier (primary research), and references from selected studies from the primary research (secondary research).

Methods:

We searched for clinical practice guidelines (NOC), meta-analysis (MA), systematic reviews (RS) and clinical trials (EC) published between January 2008 and April 2018, in English, Spanish or Portuguese, using the MeSH terms ‘Urinary Tract Infections’ and ‘Postmenopause’, and ‘Estrogens’. To assess the level of evidence and recommendation strength we used the rating system Strength Of Recommendation Taxonomy (SORT), from the American Family Physician. EC were evaluated by the Jadad scale.

Results:

From the primary research we obtained 69 studies, from which seven were selected taking into consideration the inclusion criteria: three NOC and four RS. We did not find EC published in the selected period. Most of RS and NOC used the same studies as references, however, their conclusions and strength recommendations were different, probably reflecting the limitations of the available evidence.

Conclusions:

Due to the existence of a few EC, all low-quality, we attributed a recommendation strength of B according to the American Family Physician rating system to the use of topical estrogens in postmenopause women for the prevention of recurrent UTI. However, there is a need for more high-quality studies, with homogenous methods and bigger samples and follow-up periods, that support the evidence of improving patient-oriented results.

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