Infección urinaria recurrente en la mujer posmenopáusica, Vacunas 

Las vacunas podrían ser una alternativa de primera línea, cuando fracasa la profilaxis antibiótica, en la prevención de la infección del tracto urinario recurrente; son de utilidad cuando los antibacterianos están limitados por sus efectos adversos y por el crecimiento de cepas bacterianas resistentes; es más conocido el uso de cepas avirulentas de E. Coli modificadas mediante ingeniería genética, inoculadas en mujeres que no responden al manejo convencional96,97.

Se tiene experiencia con dos tipos de vacunas, cada una con una vía de administración diferente98; una vacuna oral (Uro-Vaxom® / OM89) compuesta de fracciones inmunoestimulantes de extractos proteicos liofilizados de 18 serotipos de E. coli uropatógenas99, cuyo mecanismo de acción consiste en estimular sistema de Mucosa Asociada a Tejido Linfoide (MALT) y el sistema fagocítico mononuclear. En Colombia se encuentra disponible, y viene en cápsulas de 60 mg de liofilizado estandarizado correspondientes a 6 mg de lisados bacterianos liofilizados de Escherichiacoli100. Se toma una cápsula vía oral, al día, durante 3 meses, con refuerzo los primeros 10 días de los meses 7, 8 y 9, y con un seguimiento de 12 meses101.

Otra de las presentaciones disponibles es la vacuna vaginal (SolcoUrovac®); una vacuna de células completas con 10 cepas uropatógenas humanas muertas (seis de E. coli y una cepa de cada una de las siguientes especies: Enterococcus faecalis, Klebsiella pneumoniae, Proteus mirabilis y Proteus morganii), usada vía vaginal, incorporada en un supositorio. Se indica una semanal durante tres semanas, con un refuerzo mensual durante tres meses (seis dosis), con una tasa de erradicación del 75%102.

Probióticos 

Son productos que contienen un número suficiente de microorganismos vivos con un efecto beneficioso sobre la salud, a través de una alteración positiva de la microbiota por colonización103; sin embargo, su eficacia clínica demostrada para la profilaxis de las infecciones del tracto urinario recurrentes no es universal en la actualidad; por lo que tan solo se recomienda utilizar las cepas de Lactobacillus. La administración por vía oral y/o vaginal de L. crispatus, L. jensenii, L. rhamnosus GG o L. fermentum ha mostrado ser segura y reducir el riesgo de infecciones del tracto urinario. Estos productos pueden emplearse intravaginalmente una o dos veces a la semana con fines de profilaxis, o de uso diario el producto oral, debido a que puede restablecer los lactobacilos vaginales, competir con los patógenos genitourinarios y prevenir las infecciones104-106.

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