From the Guidelines
The most effective methods for preventing recurrent urinary tract infections (UTIs) include continuous or postcoital antimicrobial prophylaxis, cranberry products, vaginal estrogen, increased water intake, and methenamine hippurate. According to the guidelines for the prevention, diagnosis, and management of urinary tract infections in pediatrics and adults, a consensus statement published in JAMA Network Open in 2024 1, these strategies have been shown to reduce the risk of recurrent UTIs.
Strategies for Prevention
- Continuous or postcoital antimicrobial prophylaxis: This can be achieved with trimethoprim-sulfamethoxazole (TMP/SMX) 40 mg/200 mg once daily or 40 mg/200 mg three times weekly, or nitrofurantoin 50 mg or 100 mg daily, as stated in the guidelines 1.
- Cranberry products: Cranberry products containing proanthocyanidin levels of 36 mg can reduce recurrent UTIs in women, children, and individuals susceptible to UTIs, as recommended in the guidelines 1.
- Vaginal estrogen: Vaginal estrogen, such as vaginal rings, vaginal insert, or vaginal cream, can benefit postmenopausal women by improving vaginal flora and acidity, as suggested in the guidelines 1.
- Increased water intake: Drinking an additional 1.5L of water can decrease UTIs in healthy women, as shown in a randomized clinical trial (RCT) mentioned in the guidelines 1.
- Methenamine hippurate: Methenamine hippurate 1 g twice daily can reduce UTIs in patients without incontinence and a fully functional bladder, as recommended in the guidelines 1.
Considerations
When considering these strategies, it is essential to weigh the benefits against the potential risks, such as antimicrobial resistance and adverse drug events. The guidelines emphasize the importance of balancing the need for prevention with the risk of adverse effects 1.
Additional Recommendations
Other studies, such as those published in The Journal of Urology in 2018 1, support the use of these strategies and provide additional recommendations, including the use of low-dose post-coital antibiotics for recurrent UTI associated with sexual activity in premenopausal women and low-dose daily antibiotic prophylaxis in premenopausal women with infections unrelated to sexual activity. However, the most recent and highest-quality study, published in JAMA Network Open in 2024 1, should be prioritized when making definitive recommendations.
From the Research
Methods for Preventing Recurrent UTIs
- Increased fluid intake: a common non-antibiotic prevention measure discussed in the literature 2, 3
- Vaginal estrogen therapy: a non-antibiotic prevention measure that has been shown to be effective in preventing recurrent UTIs 2, 3
- Methenamine: a non-antibiotic prevention measure that has been discussed in the literature as a potential option for preventing recurrent UTIs 2
- Cranberry: a non-antibiotic prevention measure that has been shown to be effective in preventing recurrent UTIs 2, 3
- Antibiotic prophylaxis: a prevention measure that can be effective for carefully selected patients, but should be used judiciously due to the risk of antibiotic resistance 2, 4, 3
- Low-dose daily or postcoital antimicrobial prophylaxis: a prevention measure that has been shown to be effective in preventing recurrent UTIs 4
- Self-diagnosis and self-treatment with antibiotics: a prevention measure that can be effective for women who are able to self-diagnose and self-treat their UTIs 4
- Lifestyle changes: such as wiping from front to back, urinating after sexual activity, and increasing fluid intake, which can help to prevent UTIs 3
Non-Antibiotic Prevention Strategies
- Lactobacilli strains (oral and vaginal): a potential non-antibiotic prevention strategy that warrants further study 4
- Oral immunostimulant OM-89: a potential non-antibiotic prevention strategy that warrants further study 4
- Transvaginal estrogen: a non-antibiotic prevention strategy that has been shown to be effective in preventing recurrent UTIs 3
Antibiotic Treatment Options
- Nitrofurantoin: a first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females 5
- Fosfomycin tromethamine: a first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females 5
- Pivmecillinam: a first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females 5
- Cephalexin: a second-line option for the treatment of UTIs 5
- Cefixime: a second-line option for the treatment of UTIs 5
- Fluoroquinolones: a second-line option for the treatment of UTIs, but should be used judiciously due to the risk of antibiotic resistance 5
- β-lactams: a second-line option for the treatment of UTIs, but should be used judiciously due to the risk of antibiotic resistance 5