How can I prevent urinary tract infections (UTIs)?

Preventing Urinary Tract Infections (UTIs)

To prevent urinary tract infections, implement lifestyle modifications first, including increased fluid intake, proper hygiene practices, and post-coital voiding, before considering medical interventions such as vaginal estrogen for postmenopausal women or antimicrobial prophylaxis when non-antimicrobial measures fail. 1

Non-Antimicrobial Prevention Strategies

Lifestyle and Behavioral Modifications

• Increase fluid intake, especially for premenopausal women, as this may reduce the risk of recurrent UTIs 1
• Maintain proper hygiene practices, including wiping from front to back 2
• Void after sexual intercourse 2
• Avoid prolonged holding of urine 1
• Avoid disruption of normal vaginal flora with harsh cleansers or spermicides 1
• Control blood glucose in diabetics 1
• Avoid sequential anal and vaginal intercourse 1
• Avoid prolonged antibiotic courses (>5 days), broad spectrum or unnecessary antibiotics 1

Supplements and Non-Prescription Options

• Consider cranberry products, though evidence is weak with contradictory findings 1
• Consider D-mannose, though patients should be informed of the overall weak and contradictory evidence 1
• Use probiotics (local or oral) containing strains with proven efficacy for vaginal flora regeneration 1
• Consider methenamine hippurate for women without abnormalities of the urinary tract (strong recommendation) 1

Population-Specific Interventions

For Postmenopausal Women

• Use vaginal estrogen replacement (strong recommendation) 1
• Consider combining vaginal estrogen with lactobacillus-containing probiotics 1
• Address risk factors specific to this population:
  • Atrophic vaginitis due to estrogen deficiency 1
  • Urinary incontinence 1
  • High post-void residual urine volume 1

For Premenopausal Women with Post-Coital UTIs

• Consider low-dose antibiotic taken within 2 hours of sexual activity for 6-12 months 1
• Nitrofurantoin 50 mg, trimethoprim-sulfamethoxazole 40/200 mg, or trimethoprim 100 mg are preferred options 1
• Avoid fluoroquinolones and cephalosporins when possible 1

When Non-Antimicrobial Measures Fail

Antimicrobial Prophylaxis

• Use continuous or post-coital antimicrobial prophylaxis when non-antimicrobial interventions have failed (strong recommendation) 1
• Counsel patients regarding possible side effects of long-term antibiotic use 1
• Consider rotating antibiotics at 3-month intervals to avoid selection of antimicrobial resistance 1
• For patients with good compliance, self-administered short-term antimicrobial therapy should be considered (strong recommendation) 1

Advanced Interventions

• Consider immunoactive prophylaxis to reduce recurrent UTI in all age groups (strong recommendation) 1
• For patients where less invasive approaches have been unsuccessful, consider endovesical instillations of hyaluronic acid or a combination of hyaluronic acid and chondroitin sulfate 1

Common Pitfalls to Avoid

• Don't treat asymptomatic bacteriuria in women with recurrent UTIs, as this fosters antimicrobial resistance and increases recurrence episodes 1
• Avoid classifying patients with recurrent UTIs as "complicated" as this often leads to use of broad-spectrum antibiotics with long durations of treatment 1
• Don't perform extensive routine workup (e.g., cystoscopy, full abdominal ultrasound) in women younger than 40 years with recurrent UTI and no risk factors 1
• Avoid reusing catheters for those requiring intermittent catheterization, as this significantly increases UTI risk 1

Remember that recurrent UTIs negatively impact quality of life, affecting social and sexual relationships, self-esteem, and capacity for work 1. A systematic approach to prevention can significantly reduce this burden.