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Topical Vaginal Oestrogen UTI Prevention CKD — ESENeph MCQ

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EasyChronic Kidney DiseaseTopical Vaginal Oestrogen UTI Prevention CKDESENeph

A 45-year-old woman with CKD G3a has recurrent urinary tract infections. She has completed menopause and has vaginal atrophy. Her urogynaecologist suggests topical vaginal oestrogen. Is this appropriate?

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Correct answer: D — Topical vaginal oestrogen is effective for recurrent UTI prevention in postmenopausal women by restoring vaginal pH and Lactobacillus colonisation – it has minimal systemic absorption and is recommended by NICE NG109 as a non-antibiotic measure before long-term prophylactic antibiotics

NICE NG109 (UTI, 2018) recommends topical vaginal oestrogen as a non-antibiotic measure for recurrent UTI prevention in postmenopausal women. The mechanism involves restoring vaginal epithelial health, normalising vaginal pH (reducing pathogenic bacterial colonisation), and promoting Lactobacillus growth. Systemic absorption from topical formulations (pessaries, cream, ring) is minimal, making it safe in CKD. This is an underutilised intervention that can reduce antibiotic exposure – important in CKD where antibiotic stewardship matters and repeated courses increase resistance and C.difficile risk.

Reference: NICE NG109 2018 – UTI; Cochrane 2008 – Oestrogen for UTI Prevention