What are preventive medications for Urinary Tract Infection (UTI)?

From the Guidelines

Preventive Medications for Urinary Tract Infections (UTIs)

The most effective preventive medications for UTIs include Trimethoprim-Sulfamethoxazole (TMP-SMX) at a dose of 40 mg/200 mg once daily or 40 mg/200 mg three times weekly, or Nitrofurantoin at a dose of 50 mg or 100 mg daily, as supported by 1.

Alternative Options

• Methenamine Hippurate at a dose of 1 gram orally twice daily is also recommended as an alternative to prophylactic antibiotics in patients with intact bladder anatomy, as indicated by 1.
• Vaginal estrogen, such as vaginal rings, vaginal insert, or vaginal cream, is recommended for postmenopausal women, as stated in 1.
• Cranberry products containing proanthocyanidin levels of 36 mg can reduce recurrent UTIs in women, children, and individuals susceptible to UTIs, although the evidence is not as strong as for antibiotic prophylaxis, as noted in 1.

Non-Antibiotic Preventive Measures

• Increased water intake, with an additional 1.5L of water, has been shown to decrease UTIs in healthy women, as mentioned in 1.
• Probiotics and vaccines are not generally recommended due to insufficient evidence, as stated in 1.

Considerations

The choice of preventive medication should be based on individual needs, medical history, and the potential for adverse effects. It's essential to consult a healthcare provider to determine the best preventive strategy, considering factors such as the risk of antimicrobial resistance and the patient's specific condition, as emphasized in 1.

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 medications for UTI include:
  • Methenamine Hippurate (PO) for prophylactic or suppressive treatment of frequently recurring urinary tract infections 2
  • Trimethoprim-Sulfamethoxazole (PO) with a recommended dosage for prophylaxis in adults of 1 DS tablet daily 3

From the Research

Preventive Medications for Urinary Tract Infection (UTI)

Preventive medications for UTI include:

• Continuous antibiotic prophylaxis
• Postcoital antibiotic prophylaxis
• Acute self-treatment 4, 5 Specific antibiotics that can be used for prevention include:
• Nitrofurantoin
• Trimethoprim (or cotrimoxazole)
• Fosfomycin trometamol 4
• Methenamine hippurate, which may be an alternative to trimethoprim for the prevention of recurrent UTI 6

Non-Antimicrobial Strategies

Non-antimicrobial strategies for preventing UTI include:

• Vaginal estrogen substitution, particularly in postmenopausal patients 4, 5
• Cranberry products, although the evidence for their effectiveness is variable 4, 7, 5
• Probiotics, such as lactobacilli strains (oral and vaginal) 7, 8
• Immunostimulation, including the oral immunostimulant OM-89 8