Ural Sachets Are Not Recommended for Treatment of Urinary Tract Infections
Urinary alkalinisers like Ural sachets should not be used for treating urinary tract infections, as there is no reliable evidence supporting their efficacy, and current guidelines recommend against their use. 1
Evidence Against Urinary Alkalinisers
The most definitive evidence comes from a 2016 Cochrane systematic review that found zero randomised controlled trials meeting inclusion criteria to support the use of urinary alkalisers for uncomplicated UTI treatment 1. This represents the highest quality evidence available, and the conclusion is clear: the safety and efficacy of urinary alkalisers remains unknown 1.
Why This Matters
- Lack of proven benefit: Despite widespread use in some countries and inclusion in national formularies, empirical evidence is completely absent 1
- Potential for delayed appropriate treatment: Using ineffective symptomatic treatments may delay proper antimicrobial therapy when indicated
- Guidelines explicitly advise against use: Some healthcare guidelines specifically recommend against urinary alkalinisers for UTI 1
What Should Be Used Instead
For Uncomplicated Cystitis (Women)
First-line antimicrobial options include: 2
- Fosfomycin trometamol 3g single dose 2
- Nitrofurantoin 50-100mg four times daily for 5 days 2
- Pivmecillinam 400mg three times daily for 3-5 days 2
For Complicated UTIs
Empirical treatment requires combination therapy: 2
- Amoxicillin plus aminoglycoside, OR 2
- Second-generation cephalosporin plus aminoglycoside, OR 2
- Intravenous third-generation cephalosporin 2
Treatment duration should be 7-14 days depending on clinical factors 2
Critical Diagnostic Steps
Before initiating any treatment: 2
- Urine culture and sensitivity testing should be performed for symptomatic UTI 2
- Antibiotic choice must be re-evaluated once culture results are available 2
- Do not treat asymptomatic bacteriuria - this is a key pitfall 2
Common Pitfalls to Avoid
- Routine dipstick testing is not recommended in catheterised patients, as pyuria has no predictive value for differentiating symptomatic UTI from asymptomatic bacteriuria 2
- Urine odour, cloudiness, or pyuria alone in asymptomatic patients are not sufficient to indicate infection requiring treatment 2
Limited Historical Data on Alkalinisation
While older studies from 1984 suggested sodium citrate provided symptomatic relief in about 80% of women without definite bacterial infection 3, this evidence is:
- Over 40 years old with outdated methodology 3
- Not replicated in modern systematic reviews 1
- Insufficient to support current clinical use
The combination of nalidixic acid with sodium citrate showed some efficacy in historical studies 4, 5, but this reflects the antimicrobial component, not the alkaliniser itself.
Bottom Line
Use evidence-based antimicrobial therapy for confirmed UTI, not urinary alkalinisers. The absence of quality evidence combined with explicit guideline recommendations against their use makes Ural sachets inappropriate for UTI treatment 1.