From the Guidelines
To prevent urinary tract infections (UTIs), the most effective methods include drinking plenty of water, urinating frequently, practicing good hygiene, and considering cranberry supplements or vaginal estrogen cream for high-risk individuals, as recommended by the most recent guidelines 1. The key strategies for preventing UTIs can be summarized as follows:
- Drinking additional water, with a study suggesting an extra 1.5L of water can decrease UTIs in healthy women 1
- Using cranberry products containing proanthocyanidin levels of 36 mg, which can reduce recurrent UTIs in women, children, and individuals susceptible to UTIs 1
- Considering vaginal estrogen, such as vaginal rings, vaginal insert, or vaginal cream, for postmenopausal women to improve vaginal pH and flora 1
- Using methenamine hippurate, 1 g twice daily, as an alternative to prophylactic antibiotics in patients with intact bladder anatomy 1 Some additional measures that may help prevent UTIs include:
- Urinating frequently and always after sexual intercourse to expel bacteria before they can multiply
- Wiping from front to back after using the toilet to prevent bacteria from the anal area entering the urethra
- Practicing good hygiene, including washing the genital area daily with mild soap and water
- Avoiding using irritating feminine products like douches or scented sprays in the genital area It's essential to note that the decision to use antibiotic prophylaxis must balance the need for prevention against the risk of adverse drug events, antimicrobial resistance, and microbiome disruption, as highlighted in the guidelines 1. For women who experience recurrent UTIs, their doctor may recommend low-dose prophylactic antibiotics or post-intercourse single-dose antibiotic, as suggested by previous studies 1. However, the most recent guidelines prioritize the use of methenamine hippurate as an alternative to prophylactic antibiotics in patients with intact bladder anatomy 1.
From the FDA Drug Label
Methenamine Hippurate Tablets are indicated for prophylactic or suppressive treatment of frequently recurring urinary tract infections when long-term therapy is considered necessary. The methods for preventing Urinary Tract Infections (UTI) include:
- Prophylactic treatment with Methenamine Hippurate Tablets for frequently recurring UTIs when long-term therapy is necessary 2
- Suppressive treatment with Methenamine Hippurate Tablets for frequently recurring UTIs when long-term therapy is necessary 2 Note that the use of Methenamine Hippurate Tablets should only be considered after eradication of the infection by other appropriate antimicrobial agents.
From the Research
Methods for Preventing Urinary Tract Infections (UTI)
- Nonantibiotic prevention strategies for recurrent urinary tract infections (rUTIs) include:
- Vaginal estrogen, which is well tolerated and effective for preventing rUTI in postmenopausal women 3
- Cranberry supplements at sufficient doses, which are effective in preventing uncomplicated rUTI 3
- Methenamine, d-mannose, and increased hydration, which have evidence to support their use, although the evidence is of somewhat variable quality 3
- Behavioral changes, such as:
- Other preventive measures, including:
Importance of Targeted Treatment and Prevention
- Precise targeting of treatments and preventive measures is crucial to limit bacterial resistance 6
- Treatment recommendations for an acute episode of rUTI do not differ from those for isolated episodes, but prophylactic approaches play an important role in managing rUTI 5
- Antibiotic therapy should not be used routinely for people with asymptomatic bacteriuria, and healthcare professionals should follow local prescribing guidelines when antibiotics are required 4