From the Guidelines
To prevent frequent urinary tract infections, it is recommended to drink plenty of water, urinate regularly, and practice good hygiene, as well as consider preventive antibiotics or vaginal estrogen cream for postmenopausal women, as supported by the most recent and highest quality study 1. The strategies for preventing UTIs can be categorized into lifestyle modifications, non-antibiotic interventions, and antibiotic prophylaxis.
- Lifestyle modifications include:
- Drinking plenty of water (at least 6-8 glasses daily) to help flush out bacteria from the urinary tract 1
- Urinating regularly, especially after sexual activity, to prevent bacterial accumulation 1
- Wiping from front to back after using the toilet to prevent bacteria from the anal area reaching the urethra 1
- Practicing good hygiene and avoiding irritating feminine products like douches and powders 1
- Wearing breathable cotton underwear and avoiding tight-fitting pants 1
- Non-antibiotic interventions include:
- Cranberry products, which may help prevent bacteria from adhering to the urinary tract lining, although the evidence is low and contradictory 1
- Vaginal estrogen cream, which may help postmenopausal women by improving tissue health and reducing the risk of UTIs 1
- D-mannose supplements (2g daily), which can also be effective for some people, although the evidence is weak and contradictory 1
- Antibiotic prophylaxis may be recommended for those with recurrent UTIs (3+ infections per year), including low-dose nitrofurantoin (50-100mg), trimethoprim-sulfamethoxazole (40/200mg), or cephalexin (250mg) taken daily or after intercourse 1. It is 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 1. Additionally, patients should be informed about the potential benefits and risks of each strategy, and the choice of intervention should be individualized based on the patient's specific needs and medical history 1.
From the Research
Preventing Frequent Urinary Tract Infections (UTIs)
To prevent frequent UTIs, several strategies can be employed:
- Increased Fluid Intake: Drinking more fluids, especially water, can help prevent UTIs by flushing out bacteria from the urinary tract 2, 3.
- Antimicrobial Prophylaxis: The use of antimicrobials such as trimethoprim-sulfamethoxazole (TMP-SMX) can be effective in preventing UTIs, especially in individuals with a history of recurrent infections 4, 5. However, the effectiveness of TMP-SMX may be reduced in areas with high resistance rates 6.
- Urinary Tract Health: Maintaining good urinary tract health through practices such as urinating when the need arises, wiping from front to back, and avoiding certain foods that may irritate the bladder can also help prevent UTIs.
Non-Antibiotic Interventions
Non-antibiotic interventions, such as increased fluid intake, are being investigated as a strategy to reduce antibiotic prescribing for UTIs and subsequent antibiotic resistance:
- Systematic Reviews: Systematic reviews have been conducted to evaluate the effectiveness of increased fluid intake as a preventive intervention for UTIs in adults and children 2, 3.
- Randomized Controlled Trials: Randomized controlled trials have been conducted to assess the impact of increased fluid intake on UTI recurrence, antimicrobial use, and UTI symptoms 2, 3.
Considerations
When considering strategies to prevent frequent UTIs, the following should be taken into account:
- Individual Risk Factors: Individual risk factors, such as a history of recurrent UTIs, should be considered when determining the best prevention strategy.
- Resistance Rates: The effectiveness of antimicrobials such as TMP-SMX may be reduced in areas with high resistance rates 6.
- Potential for Harm: The potential for harm associated with increased fluid intake is minimal, making it a potentially useful strategy for preventing UTIs 3.