***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: We conducted a r and omized , double-blind , placebo-controlled study to determine the efficacy of postcoital antibiotic prophylaxis in healthy young women prone to recurrent urinary tract infections . Sixteen patients were r and omized to receive postcoital administration of a combination product of trimethoprim and sulfamethoxazole , while 11 received postcoital placebo .  The treatment groups were similar with respect to age , parity , diaphragm use , history of lifetime urinary tract infections , frequency of intercourse , and number of lifetime sexual partners . In over 6 months of observation , postcoital administration of trimethoprim-sulfamethoxazole was highly effective in preventing recurrent urinary tract infections . Nine of 11 patients who took the placebo developed urinary tract infections ( infection rate , 3.6 per patient-year ) , compared with only two of 16 patients who received postcoital trimethoprim-sulfamethoxazole ( infection rate , 0.3 per patient-year ) . Postcoital administration of trimethoprim-sulfamethoxazole was effective in patients with both low ( two or fewer times per week ) and high ( three or more times per week ) intercourse frequencies . Side effects were few and compliance was excellent . We conclude that postcoital trimethoprim-sulfamethoxazole is a safe , effective , and inexpensive approach to management of recurrent urinary tract infections in young women PURPOSE We evaluated and compared the efficacy of post-intercourse and daily oral ciprofloxacin prophylaxis against  recurrent lower urinary tract infections in 135 sexually active premenopausal women . MATERIAL S AND METHODS Post-intercourse ( group 1 , 70 patients ) and daily ( group 2 , 65 patients )  prophylactic regimens of 125 mg . ciprofloxacin were started following a curative , conventional treatment of the initial acute urinary tract infection . Prophylaxis was maintained for 12 months and during this period patients were followed clinical ly and bacteriologically with urine and introital sample s. Patients were subsequently followed for an additional year after the end of preventive treatment . RESULTS While 3.67 urinary tract infections per patient in group 1 and 3.74 in group 2 occurred during an identical mean time of 12.2 months before start of the corresponding prophylactic regimen , only 0.043 infection per patient in group 1 and 0.031 in group 2 developed during prophylaxis ( p < 0.0001 ) . Before prophylaxis 86 % of the vaginal vestibule cultures yielded gram-negative Enterobacteriaceae , equally distributed between both treatment arms , compared to 5.6 % and 2.5 % during postcoital and daily prophylaxis , respectively . The overall improvement in the incidence of the urinary infections per patient and the rate of introital colonization with enteric gram-negative bacteria was maintained after the end of prophylaxis , with a mean incidence of infections of 0.44 per patient ( occurring in 34 % of the total patient population ) , while 36 % of all women had abnormal introital colonization . CONCLUSIONS Long-term post-intercourse prophylaxis with ciprofloxacin proved to be equally effective as daily prophylaxis , and the major advantage of the former therapy was use of only a third of the amount of drug consumed in daily prophylaxis To study once-daily antimicrobial prophylaxis of urinary tract infections , we gave trimethoprim-sulfamethoxazole ( 40 mg/200 mg ) , trimethoprim ( 100 mg ) , nitrofurantoin macrocrystals ( 100 mg ) , or placebo to 60 women for 6 months . During prophylaxis , infections per patient year were comparable in the groups receiving trimethoprim ( 0.0 ) , nitrofurantoin ( 0.14 ) , or trimethoprim-sulfamethoxazole ( 0.15 ) and occurred less frequently than in patients receiving placebo ( 2.8 ; P less than 0.001 , placebo versus each drug regimen ) . The effectiveness of prophylaxis was limited to the 6 months that antimicrobials were given , and infections were more likely to develop after prophylaxis in women who had three or more infections in the year before prophylaxis ( P less than 0.005 ) . Further , women whose preprophylaxis infection was positive for antibody-coated bacteria were more likely to have same-strain relapse when infections recurred ( P = 0.001 ) . Emergence of trimethoprim-resistant Escherichia coli was rare , but non-E. coli infections occurred more often after prophylaxis ( P less than 0.05 ) . Prophylaxis with these drugs is effective , well tolerated , and did not produce emergence of resistant E. coli but may predispose to non-E. coli urinary tract infections after its discontinuation BACKGROUND cranberry juice is often given to older people in hospital to prevent urinary tract infection ( UTI ) , although there is little evidence to support its use . OBJECTIVE to assess whether cranberry juice ingestion is effective in reducing UTIs in older people in hospital . DESIGN r and omised , placebo-controlled , double-blind trial . SETTING Medicine for the Elderly assessment and rehabilitation hospital wards . SUBJECTS 376 older patients in hospital . METHODS participants were r and omised to daily ingestion of 300 ml of cranberry juice or matching placebo beverage . The primary outcome was time to onset of first UTI . Secondary outcomes were adherence to beverage drinking , courses of antibiotics prescribed , and organisms responsible for UTIs . RESULTS a total of 21/376 ( 5.6 % ) participants developed a symptomatic UTI : 14/189 in the placebo group and 7/187 in the cranberry juice group . These between-group differences were not significant , relative risk ( RR ) 0.51 [ 95 % CI 0.21 - 1.22 , P = 0.122 ) . Although there were significantly fewer infections with Escherichia coli in the cranberry group ( 13 versus 4 ) RR 0.31 [ 95 % CI 0.10 - 0.94 , P = 0.027 ] , this should be interpreted with caution as it was a secondary outcome . CONCLUSION despite having the largest sample size of any clinical trial yet to have examined the effect of cranberry juice ingestion , the actual infection rate observed was lower than anticipated , making the study underpowered . This study has confirmed the acceptability of cranberry juice to older people . Larger trials are now required to determine whether it is effective in reducing UTIs in older hospital patients We compared the efficacy and safety of estriol-containing vaginal pessary use with those of oral nitrofurantoin macrocrystal ( NM ) therapy for preventing urinary tract infection ( UTI ) in postmenopausal women with recurrent UTI . Over a period of 9 months , 86 women received an  estriol-containing vaginal pessary ( 0.5 mg estriol ) twice weekly , and 85 women received NM ( 100 mg ) once daily . We recorded 124 episodes of UTI in women who received estriol-releasing pessaries and 48 episodes of UTI in women treated with NM ( P=.0003 ) . Twenty-eight women ( 32.6 % ) who received estriol had no episodes of UTI versus 41 women ( 48.2 % ) in the NM group . There was a significant increase in the number of superficial cells in women who received estriol , whereas in the NM group , no such changes occurred . However , there was no change in the extent of Lactobacillus colonization and in the vaginal pH in women who received estriol . Use of an estriol-containing pessary is less effective than oral NM therapy in the prevention of bacteriuria in postmenopausal women because of its failure to restore the population of lactobacilli and to reduce the vaginal pH in these women OBJECTIVE The primary objective was to detect a difference in time until the first recurrence of urinary tract infection during treatment with an estradiol-releasing silicone vaginal ring ( Estring ; Pharmacia & Upjohn , Inc , Uppsala , Sweden ) compared with no estrogen treatment . The secondary objective was to detect any differences in improvement of urethral and vaginal mucosal atrophy and in the subjective assessment of urogenital symptoms . The study also sought to detect a difference in decrease of vaginal pH to < 5.5 and to record adverse events . STUDY DESIGN This was a multicenter , r and omized , open , parallel-group study with an untreated control group . Postmenopausal women with recurrent symptomatic , bacteriologically confirmed urinary tract infections were r and omly assigned to receive either Estring ( 2 mg estradiol ) or no estrogen treatment . One ring was carried vaginally for 12 weeks . The duration of treatment was 36 weeks for the Estring group and either 36 weeks or until the first recurrence for the control group . Both intent-to-treat and per- protocol analyses were performed to evaluate efficacy , whereas the safety analysis was limited to the intent-to-treat group . The primary variable was analyzed by survival analysis with the Kaplan-Meier method for estimating the survival density function . To compare the survival curves for the 2 treatment groups a log-rank test was performed for time until first recurrence . RESULTS A total of 108 women were r and omly assigned , 53 to the Estring group and 55 to the control group . The cumulative proportion of women remaining free of urinary tract infection was significantly higher in the Estring group than in the control group ( P = .008 ) . After 36 weeks of study the cumulative likelihood of remaining free of disease was approximately 45 % in the women with the vaginal ring compared with approximately 20 % in the control group . Estring lowered vaginal pH , and the time to first recurrence was effectively prolonged by Estring treatment . Vaginal and , to a lesser extent , urethral mucosal cells were significantly more mature in the Estring group . No unexpected adverse events were found . CONCLUSION Estring is useful to prolong the time to next recurrence among postmenopausal women with recurrent urinary tract infection and to decrease the number of recurrences per year . The silicone vaginal ring also has a clinical ly significant ability to alleviate other postmenopausal urogenital symptoms . Estring is safe and well tolerated OBJECTIVE To evaluate the efficacy of vesical instillation of hyaluronic acid against  recurrent urinary tract infections .  METHODS Twenty women with a history of recurrent urinary tract infections each received 9 intravesical instillations of hyaluronic acid over 6 months . Their status was assessed prospect ively over 47.6 weeks and compared with a retrospective review of patient charts covering 36.2+/-6.2 weeks . RESULTS The total numbers of urinary tract infections were 67 before and 10 after treatment ( p<0.001 ) . Thirteen patients ( 65 % ) were free of recurrences until the end of the study . One had a recurrence during treatment , and 6 ( 30 % ) during follow-up . The number of infections per year per patient was reduced from 4.99+/-0.92 to 0.56+/-0.82 ( p<0.001 ) . In women with recurrences , time to recurrence was 178.3+/-25.5 days , compared with 76.7+/-24.6 days before treatment ( p<0.001 ) . CONCLUSION Intravesical instillation of hyaluronic acid is effective in preventing recurrent urinary tract infections BACKGROUND Dysuria is one of the most common presenting complaints of young women , and urinalysis is one of the most common laboratory tests performed . Despite the fact that the midstream clean-catch technique is commonly used for urine collection , contaminated urine cultures occur with distressing regularity . The midstream clean-catch technique is time-consuming to explain , frequently not performed correctly by patients , costly for supplies , often embarrassing for patients and staff , and of unproven benefit . Therefore , we design ed a study to compare various methods of obtaining specimens for culture from acutely dysuric young women . METHODS A total of 242 consecutive female patients who presented with symptoms suggestive of a urinary tract infection were r and omized into 3 groups . The first group ( n = 77 ) was instructed to urinate into a clean container . No cleansing was done , and the specimen was not obtained midstream . The second group ( n = 84 ) was instructed to collect a midstream urine sample with perineal cleansing and spreading of the labia . In an attempt to decrease contamination from the vagina , the third group ( n = 81 ) was given the same instructions as group 2 , with the addition of using a vaginal tampon . Contamination rates were calculated for all 3 groups . RESULTS Contamination rates for the 3 groups were nearly identical ( 29 % , 32 % , and 31 % , respectively ) . Comparing the no-cleansing group with the combined cleansing , midstream groups also showed no difference in contamination rates ( 28.6 % and 31.5 % , respectively , with P = .65 ) . CONCLUSIONS In young , outpatient women with symptoms suggestive of a urinary tract infection , the midstream clean-catch technique does not decrease contamination rates BACKGROUND Recurrent urinary tract infections are a problem 
    Output:
    
OPTIONS continuous antibiotic prophylaxis , post-coital antibiotic prophylaxis , and acute self-treatment are all efficient alternatives to prevent recurrent urinary tract infection .