From the Guidelines
Preventive Medication for Urinary Tract Infections (UTIs)
For the prevention of recurrent urinary tract infections (UTIs), Trimethoprim-Sulfamethoxazole (TMP-SMX) at a dose of 40 mg/200 mg once daily or 40 mg/200 mg three times weekly, or Nitrofurantoin 50 mg or 100 mg daily, are commonly recommended medications 1. Another option is Methenamine Hippurate 1 gram orally twice daily, which is an appealing antimicrobial-sparing intervention to reduce UTIs in patients without incontinence and a fully functional bladder 1.
Non-Antibiotic Preventive Measures
In addition to antibiotic prophylaxis, non-antibiotic preventive measures should be considered, such as:
- Cranberry products containing proanthocyanidin levels of 36 mg, which can reduce recurrent UTIs in women, children, and individuals susceptible to UTIs 1.
- Vaginal estrogen, such as vaginal rings, vaginal insert, or vaginal cream, which can help prevent UTIs in postmenopausal women 1.
- Increased water intake, with an additional 1.5L of water, which may help decrease UTIs in healthy women 1.
Postcoital Prophylaxis
In some cases, postcoital prophylaxis with a single dose of TMP-SMX (40 mg/200 mg or 80 mg/200 mg) or Nitrofurantoin (50 mg or 100 mg) may be recommended for women with UTIs related to sexual activity 1.
Duration of Preventive Therapy
The duration of preventive therapy can vary but often ranges from 6 to 12 months. It's essential to consult a healthcare provider to determine the best preventive strategy based on individual needs and medical history.
Key Considerations
When considering preventive medication for UTIs, it's crucial to balance the need for prevention against the risk of adverse drug events, antimicrobial resistance, and microbiome disruption 1. Always consult a healthcare provider to determine the best preventive strategy based on individual needs and medical history.
From the FDA Drug Label
Methenamine hippurate tablets is indicated for prophylactic or suppressive treatment of frequently recurring urinary tract infections when long-term therapy is considered necessary. The recommended dosage for prophylaxis in adults is 1 sulfamethoxazole and trimethoprim DS (double strength) tablet daily
- Preventive medication options for Urinary Tract Infections (UTI) include:
- Key points:
- Methenamine Hippurate should only be used after eradication of the infection by other appropriate antimicrobial agents
- Trimethoprim-Sulfamethoxazole prophylaxis dosage is 1 DS tablet daily for adults
- The choice of preventive medication should be based on individual patient needs and susceptibility patterns 2, 3
From the Research
Preventive Medication for Urinary Tract Infections (UTI)
Overview of UTI Prevention
- Urinary tract infections (UTI) are among the most frequent bacterial infections in the community and health care setting, mostly affecting young and postmenopausal women 4.
- Recurrent UTI (rUTI) is defined as ≥3 UTI/year or ≥2 UTI/half year, and is rare in healthy men 4.
Antibiotic Prophylaxis
- Continuous antibiotic prophylaxis or postcoital prophylaxis are most effective to prevent rUTI, with nitrofurantoin, trimethoprim, and fosfomycin trometamol as first-line drugs 4, 5.
- Antibiotic prophylaxis reduces the number of uropathogens in the gut and/or vaginal flora and reduces bacterial "fitness" 4.
- The recurrence rate of rUTI can be reduced by about 90% with antibiotic prophylaxis, but it should be considered only after counseling, behavioral modification, and non-antimicrobial measures have been attempted 4.
Non-Antibiotic Prophylaxis
- Vaginal substitution of oestriol should be started first in postmenopausal patients 4.
- Oral or parenteral immunoprophylaxis is another option in patients with rUTI 4, 5.
- Prophylaxis with cranberry products, specific plant combinations, or probiotics are other possibilities with varying scientific evidence 4, 5, 6, 7.
- Methenamine hippurate may be an alternative for the prevention of recurrent UTI, with similar rates of recurrence and adverse effects to trimethoprim 8.
Special Considerations
- The prophylaxis of catheter-associated UTI should employ strategies that result in a reduction of frequency and duration of catheter drainage of the urinary tract 4.
- Treatable predisposing factors are rare in uncomplicated rUTI, but the success of prevention depends mainly on the possibility to eliminate or at least improve the complicating risk factors in complicated rUTI 4, 5.