From the Guidelines
Long-term prevention of urinary tract infections (UTIs) should prioritize non-antibiotic strategies, such as increased water intake, cranberry products, and vaginal estrogen, to reduce the risk of antibiotic resistance and improve quality of life. According to the most recent guidelines, drinking an additional 1.5L of water daily can decrease UTIs in healthy women 1. Cranberry products containing proanthocyanidin levels of 36 mg can also reduce recurrent UTIs in women, children, and individuals susceptible to UTIs 1. Vaginal estrogen, such as vaginal rings, vaginal insert, or vaginal cream, is recommended for postmenopausal women to improve tissue integrity and reduce UTI recurrence 1.
For women with recurrent UTIs (3+ infections per year), prophylactic antibiotics may be prescribed, such as low-dose nitrofurantoin (50-100mg), trimethoprim-sulfamethoxazole (40/200mg), or cephalexin (250mg) taken daily or post-intercourse 1. However, 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.
Other strategies, such as urinating frequently, practicing proper wiping technique, and considering probiotics containing Lactobacillus, can also help maintain healthy vaginal flora and reduce UTI recurrence 1. It is essential to note that the choice of antimicrobial prophylaxis should be based on the identification and susceptibility pattern of the organism causing the patient's UTI and history of drug allergies 1.
In summary, a comprehensive approach to long-term UTI prevention should include:
- Increased water intake
- Cranberry products
- Vaginal estrogen for postmenopausal women
- Prophylactic antibiotics for recurrent UTIs, when necessary
- Urinating frequently
- Practicing proper wiping technique
- Considering probiotics containing Lactobacillus
- Avoiding spermicides and switching from diaphragms to other birth control methods, if applicable.
From the Research
Long-term Prevention of UTI
- The prevention of recurrent urinary tract infections (UTI) is crucial, especially in young and postmenopausal women, as well as in patients with complicating urological factors 2.
- Continuous antibiotic prophylaxis or postcoital prophylaxis can be effective in preventing recurrent UTI, with nitrofurantoin, trimethoprim, and fosfomycin trometamol being available as first-line drugs 2.
- However, antibiotic prophylaxis should be considered only after counseling, behavioral modification, and non-antimicrobial measures have been attempted, due to the risk of adverse events and the concern of selecting resistant pathogens 2.
Non-Antibiotic Approaches
- Non-antibiotic prevention and treatment options are becoming increasingly important due to the rising rates of antimicrobial resistance 3.
- Various non-antibiotic interventions have been analyzed, including cranberry products, phytodrugs, probiotics, nonsteroidal anti-inflammatory drugs (NSAID), D-mannose, estrogens, vitamins, and immunotherapy 3.
- While these options show promise, the current evidence is not conclusive enough to replace antibiotic usage completely, and antibiotics remain the gold standard for UTI treatment and prevention 3.
Lifestyle Changes and Prevention Strategies
- Increasing fluid intake, wiping from front to back, and urinating after sexual activity are common lifestyle changes used to prevent UTIs 4.
- Transvaginal estrogen, cranberry extract, and low-dose prophylactic antibiotics are also used by some women to prevent recurrent UTI, often driven by urologists 4.
- The prophylaxis of catheter-associated UTI should employ strategies that reduce the frequency and duration of catheter drainage of the urinary tract 2.
Long-term Antibiotics in Children
- Long-term antibiotics may reduce the risk of repeat symptomatic UTI in children who have had one or more previous UTIs, but the benefit may be small and must be considered together with the increased risk of microbial resistance 5.
- The estimated reduction in risk of repeat symptomatic UTI for children taking antibiotics is similar in children with vesicoureteric reflux (VUR) compared to those without VUR, but there is considerable uncertainty due to imprecision from fewer events in the smaller group of children with VUR 5.