- Increased water intake (1.5 L/day) does improve UTI recurrence risk (Hooten, 2018) so should recommend it clinically.
- Methenamine salts are recommended to prevent UTIs. Methenamine is hydrolyzed to ammonia and formaldehyde which is felt to be bacteriostatic. Hydrolysis is increased in acidic urine which is why it is combined with Vitamin C. Broad-spectrum microbial activity and lack of resistance makes this an attractive preventative solution. The side effect profile is limited, but evidence as to its effectiveness is lacking. A 2012 Cochrane review noted that methenamine hippurate appears to be effective for a short duration in those individuals without renal tract abnormalities but may be ineffective if used long term. But current multiple center trial on the use of methenamine is being conducted (Forbes, 2018).
- D-MANNOSE is an inert monosaccharide that is rapidly metabolized and excreted in the urine. Inhibits urothelial binding of bacteria. Studies are small with an inconsistent diagnosis of UTI. It may be a preventative effect but larger studies needed as to dosing and duration of use.
- Probiotics: Living microorganisms that confer health benefits to their host when consumed and administered in adequate quantities. Lactobacillus most common vaginal microbiota and its colonization is inversely correlated with E.coli colonization in women with recurrent UTIs. Few studies on oral lactobacillus. Cochrane review noted poor evidence for use of vaginal lactobacillus but small studies available. Not sure what to recommend as to its use. Potential therapy.
Written by: Diane K. Newman, DNP, ANP-BC, FAAN is an Adjunct Professor of Urology in Surgery, Perelman School of Medicine, University of Pennsylvania and Co-Director of the Penn Center for Continence and Pelvic Health
- Forbes, R et al. Alternatives To prophylactic Antibiotics for the treatment of Recurrent urinary tract infection in women (ALTAR): study protocol for a multicentre, pragmatic, patient-randomised, non-inferiority trial. Trials. 2018 Nov 9;19(1):616. doi: 10.1186/s13063-018-2998-4.
- Foxman B, Barlow R, D'Arcy H, Gillespie B, Sobel JD. Urinary tract infection: self-reported incidence and associated costs. Ann Epidemiol. 2000 Nov;10(8):509-15. doi: 10.1016/s1047-2797(00)00072-
Hooton TM, Vecchio M, Iroz A, Tack I, Dornic Q, Seksek I, Lotan Y. Effect of Increased Daily Water Intake in Premenopausal Women With Recurrent Urinary Tract Infections: A Randomized Clinical Trial. JAMA Intern Med. 2018 Nov 1;178(11):1509-1515. doi: 10.1001/jamainternmed.2018.4204