Nonantibiotic strategies to prevent recurrent UTI in nonpregnant adults
Chen, 2023Naber, 2020Nelson, 2024Pat, 2022Wynn, 2024Zare, 2022
Data for nonantibiotic strategies to prevent recurrent urinary tract infection (UTI) has been predominantly reported for female1 patients. For males2 with recurrent UTI, consider referral to a urologist for nonantibiotic strategies to prevent UTI and evaluation for prostatic disease (eg chronic bacterial prostatitis)National Institute for Health and Care Excellence (NICE), October 2018.
Increasing water intake (up to 1.5 L daily) may reduce the risk of recurrent urinary tract infection (UTI) in premenopausal females who have inadequate fluid intake (less than 1.5 L daily)Bonkat, 2024Hooton, 2018Zare, 2022.
Intravaginal estrogen in postmenopausal females has been shown to have beneficial effects on vaginal flora and reduced the incidence of recurrent UTIBonkat, 2024Kwok, 2022Tan-Kim, 2023Zare, 2022. See Intravaginal estrogen therapy for suitable regimens.
Evidence suggests that methenamine hippurate reduces the incidence of recurrent UTI and may be a reasonable alternative to continuous antibiotic prophylaxis in nonpregnant femalesBonkat, 2024Botros, 2022Harding, 2022Wagenlehner, 2022. A suitable regimen isHarding, 2022Wynn, 2024:
methenamine hippurate 1 g orally, 12-hourly; review every 6 months. methenamine hippurate methenamine hippurate methenamine hippurate
Cranberry products may reduce the risk of recurrent UTI in nonpregnant females younger than 50 yearsMoro, 2024Williams, 2023. However, further research is required to confirm efficacy and determine the optimal product, dose and frequencyZare, 2022. There is insufficient evidence to recommend cranberry products for patients with bladder-emptying problems or older patientsWilliams, 2023.
The use of oral immunostimulants such as OM89 (heat-killed Escherichia coli) or MV140 (whole-cell heat-inactivated bacteria) has been studied in females, and there is some evidence that this may help reduce the number of episodes of recurrent UTIBonkat, 2024Kwok, 2022Lorenzo-Gomez, 2022Wagenlehner, 2022Yang, 2018; seek expert advice.
The use of intravesical instillations of hyaluronic acid and proteoglycans such as chondroitin sulfate (referred to as glycosaminoglycan [GAG] therapy) may be beneficial for some selected patients with recurrent UTI; seek expert advice from a urologistBonkat, 2024Kwok, 2022.
Ascorbic acid does not appear to be effective in preventing UTI, and the data for oral D-mannose is not convincingBonkat, 2024. At the time of writing, these agents cannot be recommended for prevention of recurrent UTI.
The use of local or oral probiotics to regenerate vaginal flora has been explored for recurrent UTI, but further information is needed to identify which strains may be useful, and what mode of administration is bestBonkat, 2024.
Intravesical administration of ‘nonvirulent’ E. coli to promote colonisation (so called competitive inoculation) needs further evaluation before it can be recommended for recurrent UTISinha, 2018.