Can apple cider vinegar and water be used to treat urinary tract infections (UTIs)?

Apple Cider Vinegar and Water for UTIs: Not Recommended as Treatment

Apple cider vinegar and water should not be used to treat urinary tract infections (UTIs), as there is no evidence supporting its efficacy, and using unproven remedies may delay appropriate antibiotic therapy, potentially leading to complications including pyelonephritis and urosepsis. 1

Evidence-Based UTI Treatment Approaches

First-Line Treatments for UTIs

• Antibiotics remain the standard of care for treating confirmed UTIs, with options including:

  • Fosfomycin trometamol (3g single dose) 1
  • Nitrofurantoin (100mg twice daily for 5 days) 1
  • Trimethoprim-sulfamethoxazole (160/800mg twice daily for 3-14 days depending on complexity) 1
  • Cephalosporins (when local E. coli resistance is <20%) 1

• Treatment duration varies based on UTI type:

  • Uncomplicated cystitis: 3-5 days 1
  • Complicated UTIs: 7-14 days 1
  • UTIs in men: typically 7-14 days (14 days when prostatitis cannot be excluded) 1

Non-Antibiotic Prevention Strategies

• Several evidence-based non-antibiotic approaches can help prevent recurrent UTIs:
  • Cranberry products containing proanthocyanidin (36mg) have demonstrated effectiveness in reducing recurrent UTIs in women and children 1, 2
  • Increased water intake (additional 1.5L daily) was shown to reduce UTI frequency in women with recurrent UTIs in a randomized controlled trial 1
  • Vaginal estrogen in postmenopausal women helps restore vaginal microbiome and reduces UTI frequency 1
  • Methenamine hippurate (1g twice daily) can be used as an antimicrobial-sparing intervention 1

Why Apple Cider Vinegar is Not Recommended

• No mention of apple cider vinegar appears in any current clinical guidelines for UTI treatment or prevention 1
• Using unproven remedies like apple cider vinegar may delay appropriate antibiotic therapy, which is necessary to:
  • Eliminate acute infection
  • Prevent complications
  • Reduce likelihood of renal damage 1
• Untreated or inadequately treated UTIs can progress to pyelonephritis or urosepsis, which can be life-threatening conditions 1

Diagnostic Considerations

• Proper diagnosis of UTIs requires:

  • Evaluation of symptoms (dysuria, frequency, urgency)
  • Urine culture in complicated cases or when symptoms persist 1
  • Significant bacteriuria is typically defined as ≥50,000 CFUs/mL of a single urinary pathogen 1

• Common causative organisms include:

  • E. coli (most common)
  • Proteus spp.
  • Klebsiella spp.
  • Pseudomonas spp.
  • Enterococcus spp. 1

Clinical Implications and Recommendations

• For active UTI infections, patients should be treated with appropriate antibiotics based on local resistance patterns 1
• For prevention of recurrent UTIs, evidence-based non-antibiotic approaches like cranberry products, increased water intake, or methenamine hippurate should be considered 1, 2
• Patients should be advised against using unproven remedies like apple cider vinegar that may delay appropriate care 1
• Antimicrobial stewardship is important given rising resistance rates, but this should involve using proven alternatives rather than unproven home remedies 3, 4

Common Pitfalls to Avoid

• Mistaking temporary symptom relief for effective treatment - some home remedies may temporarily alleviate symptoms without addressing the underlying infection 4
• Delaying appropriate antibiotic therapy, which can lead to progression of infection and complications 1
• Confusing prevention strategies with treatment approaches - while some non-antibiotic approaches may help prevent recurrent UTIs, they are not adequate for treating active infections 1, 4
• Assuming all natural remedies are effective or harmless - lack of evidence for efficacy should guide clinical decision-making 4, 5