Materiały źródłowe

• #1 Prevention of Urinary Tract Infection (UTI) in Women: General Guidelines and Suggestions, Sterilizing Washcloths for Home Use, Summary of Tips

  https://emedicine.medscape.com/article/1958794-overview

  There are a number of general guidelines and suggestions that will help women avoid urinary tract infections (UTIs) in most instances. These may be conveniently divided into the categories of hygiene, clothing, diet, activities, and medications. Most UTIs are ascending infections of bacteria that colonize the vaginal wall and eventually the urethra. From the urethra, the bacteria can travel upwards and infect the bladder (lower tract infection) or continue from the bladder up the ureters and infect the kidneys themselves (upper tract infection). The effective preventive measures are able to block this bacterial migration. […] Wipe front to back. Always wipe from the front to the back after using the bathroom. Do not try to reach from behind because germs from the rectum can be transferred to the hand and tissue.

• #2 Urinary Tract Infection (UTI): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/9135-urinary-tract-infections

  Urinary tract infection symptoms most commonly cause problems peeing, like pain and cloudy or smelly pee. […] Practicing good hygiene is one of the best ways to help prevent UTIs. This is especially important if you have a vagina because your urethra is much shorter, and its easier for E. coli to move from your rectum back into your body. Always wipe from front to back after a bowel movement (pooping) to avoid this. […] Drinking extra fluids especially water each day can help flush out bacteria from your urinary tract. Healthcare providers recommend drinking six to eight glasses of water daily. […] Peeing frequently can reduce your risk of developing an infection, especially if you get UTIs a lot. […] If you get UTIs often, methenamine hippurate is another nonantibiotic alternative that helps prevent infections. […] Over-the-counter (OTC) supplements including cranberry extract and probiotics may also help prevent UTIs. Talk to a healthcare provider before you start taking any supplements.

• #3 Prevention of Urinary Tract Infection (UTI) in Women: General Guidelines and Suggestions, Sterilizing Washcloths for Home Use, Summary of Tips

  https://emedicine.medscape.com/article/2040239-overview

  There are a number of general guidelines and suggestions that will help women avoid urinary tract infections (UTIs) in most instances. These may be conveniently divided into the categories of hygiene, clothing, diet, activities, and medications. Most UTIs are ascending infections of bacteria that colonize the vaginal wall and eventually the urethra. From the urethra, the bacteria can travel upwards and infect the bladder (lower tract infection) or continue from the bladder up the ureters and infect the kidneys themselves (upper tract infection). The effective preventive measures are able to block this bacterial migration. […] Wipe front to back. Always wipe from the front to the back after using the bathroom. Do not try to reach from behind because germs from the rectum can be transferred to the hand and tissue.

• #4 Urinary Tract Infection Basics | Urinary Tract Infection | CDC

  https://www.cdc.gov/uti/about/index.html

  UTIs are more common in females because their urethras are shorter and closer to the rectum. This makes it easier for bacteria to enter the urinary tract. […] Prevention: Urinate after sexual activity. Stay well hydrated. Take showers instead of baths. Minimize douching, sprays or powders in the genital area. Teach girls when potty training to wipe front to back.

• #5 Prevention of Urinary Tract Infection (UTI) in Women: General Guidelines and Suggestions, Sterilizing Washcloths for Home Use, Summary of Tips

  https://emedicine.medscape.com/article/1958794-overview

  Take showers and avoid prolonged baths. Bath water may fairly quickly become contaminated by the bather’s own skin florae. Sitting in a tub allows bacteria to reach the bladder opening area. […] Extremely effective is avoiding long intervals between urinating. Try to empty the bladder at least every 4 hours during the day while awake, even if the need or urge to void is absent. […] Drink more water. Start with 1 extra glass with each meal. If the urine appears any darker than a very pale yellow, this means not enough liquid is being ingested; increase the fluid intake. […] A study of 140 women with recurrent UTIs showed that increased fluid intake reduces the risk of repeat infections. […] Cranberry juice and cranberry pills may have benefit in reducing urinary infections. They appear to be most effective in younger women.

• #6 Urinary tract infection (UTI) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/symptoms-causes/syc-20353447

  Empty your bladder soon after having sex. Also drink a full glass of water to help flush bacteria. […] Avoid potentially irritating feminine products. Using them in the genital area can irritate the urethra. These products include deodorant sprays, douches and powders. […] Change your birth control method. Diaphragms, unlubricated condoms or condoms treated with spermicide can contribute to bacterial growth.

• #7 Preventing a Urinary Tract Infection (UTI)

  https://www.verywellhealth.com/urinary-tract-infections-prevention-3520513

  Shower once a day instead of bathing in a tub. Bathing can alter vaginal pH and introduce soap residue and other chemicals into the vagina. […] Fragrances used in some soaps and other bath and hygiene products can cause an allergic reaction in the vulva. […] Wipe From Front to Back: After urinating, tilt your body forward and, reach between your buttocks to start wiping from the front of the vagina to the back. […] Use Condoms: Even if you are in a monogamous relationship, condoms can prevent the transmission of bacteria during vaginal intercourse. […] Avoid Using a Diaphragm: This is important if you are prone to urinary tract infections. […] Wear Breathable Cotton Underwear: Synthetic fabrics trap moisture and create the perfect breeding ground for infection. […] Proanthocyanidins (PACs) are compounds naturally found in cranberries. Growing research has shown that PACs can help prevent urinary tract infections.

• #8 5 tips to prevent a urinary tract infection – Mayo Clinic Health System

  https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/5-tips-to-prevent-a-urinary-tract-infection

  A urinary tract infection, also called a UTI, is an infection that occurs in the urinary system. This could include the urethra, bladder, ureters and kidneys. Most infections involve the bladder and urethra, known as the lower urinary tract. […] It’s always better to prevent an infection rather than simply treat it. UTIs are no different. […] Follow these tips to lower your risk of a UTI with little or no potential negative side effects: […] Drink plenty of fluids, especially water. This helps keep bladder tissue hydrated and healthy. It also dilutes your urine and lowers the concentration of bacteria in the bladder. Some people can clear an infection on their own just by drinking fluids. Try drinking at least 50 ounces, or about 1.5 liters, of fluid daily to prevent infections. […] Empty your bladder often. Regularly emptying your bladder ensures urine is not sitting in your bladder for long periods of time. Since bacteria like warm and wet environments to grow, this takes away good living conditions for the bacteria. It’s normal to empty your bladder four to eight times per day.

• #9 Recurrent UTIs and cystitis symptoms in women

  https://www1.racgp.org.au/ajgp/2021/april/recurrent-utis-and-cystitis-symptoms-in-women

  Urinary tract infections (UTIs) are an extremely common problem in women and are a cause of great personal morbidity as well as cost to the health system. […] Both non-antibiotic and antibiotic-related strategies to treat women with rUTIs are available. […] It is recommended that the patient and doctor engage in a shared decision-making process that includes a discussion of the risks and benefits of all management options before embarking on a management plan tailored to the individual woman. […] While the advice to increase fluid intake to prevent infection is frequently given, there is little evidence to support it. […] A simple measure such as postcoital voiding can be recommended in women who note intercourse as a trigger for their UTIs. […] Spermicide or diaphragm contraceptive device usage should be avoided as these have been shown to increase UTI risk.

• #10 Prevention of Urinary Tract Infection (UTI) in Women: General Guidelines and Suggestions, Sterilizing Washcloths for Home Use, Summary of Tips

  https://emedicine.medscape.com/article/2040239-overview

  Take showers and avoid prolonged baths. Bath water may fairly quickly become contaminated by the bather’s own skin florae. Sitting in a tub allows bacteria to reach the bladder opening area. […] Extremely effective is avoiding long intervals between urinating. Try to empty the bladder at least every 4 hours during the day while awake, even if the need or urge to void is absent. […] Drink more water. Start with 1 extra glass with each meal. If the urine appears any darker than a very pale yellow, this means not enough liquid is being ingested; increase the fluid intake. […] A study of 140 women with recurrent UTIs showed that increased fluid intake reduces the risk of repeat infections. […] Cranberry juice and cranberry pills may have benefit in reducing urinary infections. They appear to be most effective in younger women.

• #11 Prevention of Urinary Tract Infection (UTI) in Women: General Guidelines and Suggestions, Sterilizing Washcloths for Home Use, Summary of Tips

  https://emedicine.medscape.com/article/1958794-overview

  Take special precautions after sexual activity; such activity may also increase risk because it can introduce bacteria into the bladder area. The bladder should be emptied after intercourse; drink 2 extra glasses of water. […] An estrogen vaginal cream may help increase resistance to bladder infections. […] Take antibiotics only as prescribed by a doctor. If a medication has been prescribed as preventive therapy, follow the physicians instructions carefully. […] The guidelines and suggestions listed above help most women avoid bladder infections most of the time. If an infection develops in spite of these precautions, promptly seek medical help. […] Tips for UTI prevention may be summarized as follows: Wipe in the correct direction, from front to back, after using the bathroom. […] Drink extra water and consider drinking cranberry juice (or taking cranberry pills). It cannot harm. […] Use an estrogen cream if postmenopausal. […] Take any medication as prescribed by a physician.

• #12 What doctors wish patients knew about UTI prevention | American Medical Association

  https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-uti-prevention

  We do know that cranberry juice does help urinary tract infections to some degree, Dr. Steers said. […] Hygiene in the bathroom is also a predisposing factor for UTIs, Dr. Bryan said, which means it is important to make sure that we cleanse from the front to the back to minimize the spread of bacteria. […] Sexual activity is definitely a predisposing factor in urinary tract infections, Dr. Bryan said, noting that sexual intercourse itself does not directly cause UTIs, but it can increase the likelihood. […] Pregnant women oftentimes dont know that they are at increased risk for urinary tract infections, or they may not be aware of the risk of progression of UTIs, Dr. Steers said. […] To prevent a hospital-acquired urinary tract infection, the biggest thing would be minimizing the amount of time the catheter is in place, she said.

• #13 Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2022) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/recurrent-uti

  Clinicians may offer cranberry prophylaxis for women with rUTIs. (Conditional Recommendation; Evidence Level: Grade C) […] Following discussion of the risks, benefits, and alternatives, clinicians may prescribe antibiotic prophylaxis to decrease the risk of future UTIs in women of all ages previously diagnosed with UTIs. (Conditional Recommendation; Evidence Level: Grade B) […] Clinicians should treat rUTI patients experiencing acute cystitis episodes with as short a duration of antibiotics as reasonable, generally no longer than seven days. (Moderate Recommendation; Evidence Level: Grade B) […] Clinicians should obtain urinalysis, urine culture and sensitivity with each symptomatic acute cystitis episode prior to initiating treatment in patients with rUTIs. (Moderate Recommendation; Evidence Level: Grade C)

• #14 Recurrent Urinary Tract Infections in Women: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0915/p638.html

  Recurrent urinary tract infections (UTIs) are common in women and associated with considerable morbidity and health care use. […] Continuous prophylaxis for six to 12 months reduces the rate of UTIs during the prophylaxis period, with no difference between the six-month and 12-month treatment groups after cessation of prophylaxis. […] Prophylactic antibiotic selection should be made on the basis of community resistance patterns, side effects, and local costs. […] Postcoital prophylaxis may be preferable in women with UTIs temporally related to intercourse. […] Although not strictly a preventive strategy, self-initiated treatment is an option for some patients. […] Cranberry products seem to notably reduce the recurrence of symptomatic cystitis. […] Several studies of postmenopausal women have demonstrated the effectiveness of using topical estrogen (0.5 mg of estriol vaginal cream nightly for two weeks, then twice weekly for eight months), but adverse effects are common. […] Prophylactic antimicrobial therapy to prevent recurrent UTIs is not recommended for patients with complicated UTIs.

• #15 Treatment and Prevention of Urinary Tract Infection

  https://www.urology-textbook.com/urinary-tract-infection-treatment.html

  Two grams of D-mannose once daily reduces (RR 0.24) the frequency of urinary tract infections. […] In postmenopausal women with recurrent urinary tract infections, vaginal estrogenization reduces the frequency of urinary tract infections. […] Low-dose antibiotic prophylaxis is considered an effective method of avoiding recurrent urinary tract infections in patients with severe symptoms or complications. […] Careful aseptic techniques for catheterizations have a short-term effect in preventing UTIs. […] Intermittent catheterization is the method of choice for bladder emptying disorders as an alternative to indwelling catheters. […] Methenamine hippurate or mandelate combined with L-methionine for urinary acidification are used to prevent CAUTI. […] A new bladder catheter is needed if there is insufficient urine flow due to encrustation or an antibiotic treatment due to CAUTI is initiated.

• #16 Recurrent UTI in Adult, Non-Pregnant Females

  https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/conditions-and-treatments/urinary/recurrent-uti-in-adult-non-pregnant-females/

  This guidance refers to non-pregnant adult females with a diagnosis of uncomplicated recurrent UTIs supported by laboratory evidence. […] Antimicrobial prophylaxis should only be considered in these groups following specialist advice. […] In non-pregnant females with recurrent lower UTI, try non-antimicrobial measures prior to antimicrobial prophylaxis. […] Give advice on behavioural measures which may reduce the risk of recurrent UTI. […] There is limited evidence that D-mannose 2 g once daily, an inert sugar which may prevent bacterial adhesion to urothelial cells, may be beneficial in preventing recurrent urinary tract infections. […] Antimicrobial prophylaxis, either single-dose (e.g. post-coital) or continuous, can be effective and should be considered if non-antimicrobial measures are unsuccessful.

• #17 UTI Symptoms, Causes, and Prevention | Mass General Brigham

  https://www.massgeneralbrigham.org/en/about/newsroom/articles/myths-and-truths-about-urinary-tract-infections

  Urinary tract infections (UTIs) are one of the most common infections in women and people assigned female at birth (AFAB), but anyone can have a UTI. […] The body’s best defense against urinary bacteria is adequate urine flow to wash away bacteria. Stay hydrated and avoid holding your pee to help prevent UTIs. […] Other strategies include: cranberry supplement taken after sex, avoiding douches, sprays, or powder in the genital area. […] Increasingly, doctors are advocating probiotics via diet (yogurt, kefir, fermented foods) or supplements. While there is no evidence that probiotics alone offer sufficient protection against UTIs, they can be effective when used along with other prevention strategies by promoting healthy vaginal and bowel flora. […] You may hear or read about prevention strategies for UTI, with cranberry supplements among the most popular. While the data is mixed about the role of cranberry to prevent UTI, using a daily cranberry supplement is a safe strategy that may help reduce your risk of E. coli UTIs. […] Women who experience recurrent UTIs can discuss possible medical prevention tips with their provider, such as low-dose antibiotics and vaginal estrogen replacement after menopause.

• #18 Management and Prevention of Recurrent Urinary Tract Infections in Women | Consultant360

  https://www.consultant360.com/articles/management-and-prevention-recurrent-urinary-tract-infections-women

  The optimal prophylactic antibiotic and ideal duration for prophylaxis is currently unknown. […] For women whose recurrent UTIs are related to sexual intercourse, postcoital prophylaxis may be a more efficient method of preventing UTIs. […] Although it is not classified as a true prevention strategy, self-administered treatment is an effective, safe, and economical way for women to manage recurrent UTIs. […] As a result, estrogen therapy has been proposed as a method for preventing UTIs in postmenopausal women. […] The use of cranberry products for the prevention of recurrent UTIs has been in practice for decades. […] The use of probiotics to restore the vaginal flora of depleted Lactobacillus species as a nonantimicrobial approach to the prevention of recurrent UTIs has been considered.

• #19 Recurrent simple cystitis in women – UpToDate

  https://www.uptodate.com/contents/recurrent-simple-cystitis-in-women

  Recurrent urinary tract infection (UTI) refers to ≥2 infections in six months or ≥3 infections in one year. […] The epidemiology, pathogenesis, and prevention of recurrent simple cystitis in nonpregnant women will be reviewed here. […] Changes in behavior: Liberal fluid intake, Contraception modification, Postcoital voiding, Hygiene. […] Topical estrogen for postmenopausal women. […] Antimicrobial prophylaxis in selected cases: Options: Continuous prophylaxis, Postcoital prophylaxis. […] Antimicrobial prophylaxis in selected cases: Duration, Adverse effects. […] Prophylaxis recurrent UTI.

• #20 Antibiotic prophylaxis for urinary tract infection | The College of Family Physicians of Canada

  https://www.cfp.ca/content/68/12/896

  Antibiotic prophylaxis lowers the risk of recurrent UTIs (12% vs 66% placebo) over 6 to 12 months. Yet, more women have adverse events with antibiotics (15% vs 8% placebo). Long-term bacterial resistance and its individual clinical impact have not been well studied. This does not apply to asymptomatic bacteriuria […] A comparison of antibiotic prophylaxis (6 to 12 months) versus placebo found the following: In a meta-analysis (10 RCTs, 430 women) of various regimens of 5 antibiotics, microbiological recurrence (8 RCTs, 372 women) was less likely among those taking antibiotics (12% vs 66% placebo; number needed to treat [NNT]=2). Occurrence of clinical UTI (eg, dysuria; 8 RCTs, 257 women) was lower with antibiotics (7% vs 51% placebo; NNT=3). […] Adverse events (eg, skin rash, nausea) were more common among those taking antibiotics (15% vs 8% placebo, number needed to harm [NNH]=14). Rates of serious adverse events did not differ.

• #21

  https://bpac.org.nz/2021/uti.aspx

  Lower urinary tract infection (UTI) is one of the most common community-acquired infections, with more than half of all females experiencing at least one episode during their lifetime. […] Self-care strategies should be discussed with all patients who have a UTI to help reduce the risk of future infections, e.g. sufficient fluid intake, improving hygiene and toileting practices and voiding after sexual intercourse. […] Non-antibiotic prophylactic strategies can be considered in patients who experience recurrent UTIs but are not routinely recommended in current guidelines due to low-quality evidence of benefit. […] Antibiotic prophylaxis is highly effective at preventing recurrent UTIs, however, this should usually only be considered as a last resort if other strategies are unsuccessful primarily due to the risk of antibiotic resistance.

• #22 Recommendations | Urinary tract infection (recurrent): antimicrobial prescribing | Guidance | NICE

  https://www.nice.org.uk/guidance/ng112/chapter/recommendations

  Manage an acute urinary tract infection (UTI) as outlined in NICE’s guideline on UTI (lower): antimicrobial prescribing or pyelonephritis (acute): antimicrobial prescribing. […] Be aware that recurrent UTI: includes lower UTI and upper UTI (acute pyelonephritis) […] Give advice to people with recurrent UTI about behavioural and personal hygiene measures and self-care treatments (see the recommendations on self-care) that may help to reduce the risk of UTI. […] Consider vaginal oestrogen for recurrent UTI if behavioural and personal hygiene measures alone are not effective or not appropriate. […] When discussing vaginal oestrogen for preventing recurrent UTI, cover the following to ensure shared decision making: the severity and frequency of previous symptoms […] Consider a trial of single-dose antibiotic prophylaxis (a one-off dose of an antibiotic) for recurrent UTI only if behavioural and personal hygiene measures, and vaginal oestrogen, are not effective or not appropriate.

• #23 Antibiotic prophylaxis in non-pregnant women with recurrent UTIs – Primary Care Notebook

  https://primarycarenotebook.com/pages/infectious-disease/antibiotic-prophylaxis-in-non-pregnant-women-with-recurrent-utis

  Recurrent urinary tract infections (UTIs) in women are common, result in considerable morbidity and expense, and can be a management problem for clinicians. Behavioural changes can be useful antimicrobial-sparing measures in the prevention of recurrent UTIs, but antimicrobial prophylaxis may be necessary in those who continue to have recurrences. Continuous prophylaxis, post-coital prophylaxis and intermittent self-treatment with antimicrobials have all been demonstrated to be effective in the prevention of recurrent uncomplicated UTIs. […] Before any prophylaxis regime is initiated then eradication of a previous UTI should be assured by a negative urine culture one to two weeks after treatment. […] Continuous prophylaxis has been demonstrated in numerous studies in different populations to decrease recurrences by 95% when compared with placebo or with patients’ prior experience (from 2.0-3.0 episodes per patient-year to 0.1-0.2 per patient-year).

• #24 Use of antibiotics to prevent recurrent urinary tract infection (UTI)

  https://www.urineincontinence.com.au/urinary-tract-infection/use-antibiotics-prevent-recurrent-urinary-tract-infection-uti

  When structural problems in the urinary tract have been excluded, antibiotics are the mainstay of treatment of recurrent urinary tract infection (UTI). […] There are several forms of antibiotic usage that can help reduce the rate of recurrent UTIs in women including: […] Low dose continuous antibiotic prophylaxis […] This involves taking a very small dose of antibiotic continuously over several months. […] The rationale is to eradicate certain bacteria that cause UTI which live on the skin and in the bowel. […] Low dose continuous antibiotics can also help treat reservoirs of bacteria that may hide inside cells in the wall of the bladder. […] After intercourse (post coital) antibiotic prophylaxis […] In women in whom UTIs are consistently triggered by sexual intercourse, use of a single low dose of antibiotic immediately after intercourse can reduce the rate of UTI.

• #25

  https://link.springer.com/article/10.1007/BF01997427

  A total of 77 sexually active premenopausal women, susceptible to recurrent urinary tract infections (UTI) but otherwise healthy, were subjected to postcoital prophylaxis consisting of a single oral dose of either cotrimoxazole (80 mg trimethoprim+400 mg sulfamethoxazole), 50 mg nitrofurantoin macrocrystals, 500 mg nalidixic acid, 250 mg cinoxacin or 250 mg cephalexin. Postcoital prophylaxis reduced the incidence of recurrent UTI from 5-8 UTI per patient/year prior to prophylaxis, to a mere 0.03 UTI per patient/ year following prophylaxis. […] Postcoital prophylaxis of recurrent UTI in premenopausal women is highly effective because of easy compliance, the high urinary concentration achieved and the minimal induction of resistance in the introital Gram-negative bacterial flora, irrespective of the length of time this prophylaxis is used. Furthermore, postcoital prophylaxis is significantly more effective than daily, as it achieves the same effect but requires only one third or fewer of the antibacterial tablets used in daily prophylaxis. At present, postcoital prophylaxis with cotrimoxazole, nitrofurantoin macrocrystals or cephalexin is recommended.

• #26 Recurrent UTI in Adult, Non-Pregnant Females

  https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/conditions-and-treatments/urinary/recurrent-uti-in-adult-non-pregnant-females/

  Review all UTI antimicrobial prophylaxis after 3-6 months with a view to de-prescribing, irrespective of whether it was started by a GP or a specialist. […] In patients with an identifiable trigger (e.g. sexual intercourse), single-dose prophylaxis (e.g. post-coital) is as effective as continuous prophylaxis in preventing recurrent UTI, but with fewer side-effects, and should thus be the preferred option. […] When a trial of antimicrobial prophylaxis is given, advise the patient regarding: The risk of resistance with long term antibiotics. […] An audit tool has been created to aid regular review of patients receiving antimicrobial urinary prophylaxis. […] Further information on de-prescribing of antimicrobial urinary prophylaxis is available.

• #27 Use of antibiotics to prevent recurrent urinary tract infection (UTI)

  https://www.urineincontinence.com.au/urinary-tract-infection/use-antibiotics-prevent-recurrent-urinary-tract-infection-uti

  Self-start antibiotic courses […] Suitable for women with occasional UTIs who are able to have an MSU specimen taken before starting a short course of oral antibiotic which has already been prescribed. […] It is important that the urine specimen is performed BEFORE any antibiotics are taken. […] Antibiotics can be started immediately with the onset of symptoms before the results of the MSU culture are available. […] Although understandably many women do not like the idea of being on long-term antibiotics, this is often much safer and healthier than suffering from ongoing infections. In many women a course of preventative antibiotics used over several months can help break the cycle of frequent UTIs for many months or even years.

• #28

  https://link.springer.com/article/10.1007/s44197-023-00105-4

  Despite being effective in reducing recurrent urinary tract infection rate, emergency room visits and hospital admissions due to UTI, continuous antibiotic prophylaxis was only used in 55% of patients with recurrent infections. […] Prevention of recurrent UTIs includes continuous and postcoital antimicrobial prophylaxis and the use of topical estrogen in postmenopausal women. […] Antimicrobial regimens commonly used for continuous antimicrobial prophylaxis include Bactrim, Fosfomycin and Nitrofurantoin. […] The use of antibiotic prophylaxis was associated with a reduction in the number of episodes of urinary tract infection and a decrease in the emergency room visits and hospitalization for UTI. […] Both Nitrofurantoin and TMP-SMX were effective in reducing number of symptomatic urinary tract infections, admissions to hospital and ER visits due to UTI in our patients. […] The overall process of caring of patients with recurrent UTI lacks adequate documentations and focus on individuals preference rather than an organized systematic approach.

• #29 Recurrent urinary tract infections and prophylactic antibiotic use in women: a cross-sectional study in primary care | British Journal of General Practice

  https://bjgp.org/content/74/746/e619

  Prophylactic antibiotic use was defined as 3 consecutive prescriptions for the same UTI-specific antibiotic (trimethoprim, nitrofurantoin, or cefalexin) with 2156 days between prescriptions. […] In total 80.8% of women with rUTIs had a urine culture reported in the 12 months before the diagnosis with high levels of resistance to trimethoprim and amoxicillin. […] As part of rUTI diagnosis and before initiating prophylactic antibiotics, more frequent urine cultures could better inform antibiotic choice for prophylaxis and treatment. […] Women with rUTIs had high levels of resistance to trimethoprim and amoxicillin, which are two of the four prophylactic antibiotics recommended in the UK. […] These findings emphasise urine cultures potential importance in informing prophylactic antibiotic choice.

• #30

  https://bpac.org.nz/2021/uti.aspx

  In all patients with recurrent UTIs, first reiterate the importance of self-care strategies, and investigate known triggers specific to the patients history, e.g. use of spermicide-containing contraceptives. […] Some other non-antibiotic prophylactic strategies that have a low risk of harm can be discussed, but their use is not routinely recommended due to a lack of high-quality evidence for efficacy. […] Low-dose antibiotic prophylaxis should generally be a last resort. […] If a decision is made to stop antibiotic prophylaxis, a back pocket antibiotic prescription can be provided to manage any acute UTIs that subsequently develop. […] Methenamine hippurate (Hiprex) 1 g every 12 hours can be considered as an alternative form of antimicrobial prophylaxis in patients with a history of recurrent UTIs to avoid long-term antibiotic use.

• #31 Recommendations | Urinary tract infection (recurrent): antimicrobial prescribing | Guidance | NICE

  https://www.nice.org.uk/guidance/ng112/chapter/recommendations

  Consider methenamine hippurate as an alternative to daily antibiotic prophylaxis for recurrent UTI in women, and trans men and non-binary people with a female urinary system, if: they are not pregnant and any current UTI has been adequately treated and they have recurrent UTI that has not been adequately improved by behavioural and personal hygiene measures, vaginal oestrogen or single-dose antibiotic prophylaxis (if any of these have been appropriate and are applicable). […] Review daily antibiotic prophylaxis for recurrent UTI at least every 6 months, with the review to include: assessing the success of prophylaxis […] Be aware that some women, and trans men and non-binary people with a female urinary system, who have recurrent UTI and are not pregnant may wish to try: Dmannose […] Be aware that evidence is inconclusive about whether probiotics (lactobacillus) reduce the risk of UTI in people with recurrent UTI. […] When prescribing antibiotic prophylaxis for recurrent UTI, take account of local antimicrobial resistance (AMR) data from the UK Health Security Agency.

• #32 Methenamine is as good as antibiotics at preventing UTIs

  https://evidence.nihr.ac.uk/alert/methenamine-as-good-as-antibiotics-preventing-urinary-tract-infections/

  The drug methenamine (which is not an antibiotic) could be as effective as antibiotics at preventing urinary tract infections. […] Methenamine could be an alternative to antibiotics for preventing frequent urinary tract infections, thereby reducing the use of antibiotics. […] Alternatives to antibiotics are needed, especially where people need to take antibiotics long-term. […] There is some evidence that methenamine, an oral antiseptic, may prevent recurrent urinary tract infections. […] The study concludes that methenamine could be an alternative to antibiotics for the prevention of recurrent urinary tract infections. […] Many women (44%) in the methenamine group had no antibiotics during the 12-month treatment period. […] The researchers say this is encouraging because it shows that methenamine can prevent recurrent infections and reduce antibiotic use.

• #33 Methenamine for urinary tract infection prophylaxis: A systematic review – PubMed

  https://pubmed.ncbi.nlm.nih.gov/37986168/

  This systematic review suggests methenamine generally appears to be an effective and well-tolerated antibiotic-sparing option for UTI prophylaxis. Furthermore, the pharmacology, dosage and formulation, warnings, precautions, and safety considerations of methenamine that provide potential clinical considerations regarding its use for UTI prophylaxis are described. Further studies are needed to evaluate the clinical utility of methenamine for UTI prophylaxis.

• #34 Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2022) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/recurrent-uti

  To make a diagnosis of rUTI, clinicians must document positive urine cultures associated with prior symptomatic episodes. (Clinical Principle) […] Clinicians should obtain a complete patient history and perform a pelvic examination in women presenting with rUTIs. (Clinical Principle) […] Clinicians should not treat ASB in patients. (Strong Recommendation; Evidence Level: Grade B) […] Clinicians should omit surveillance urine testing, including urine culture, in asymptomatic patients with rUTIs. (Moderate Recommendation; Evidence Level: Grade C) […] In peri- and post-menopausal women with rUTIs, clinicians should recommend vaginal estrogen therapy to reduce the risk of future UTIs if there is no contraindication to estrogen therapy. (Moderate Recommendation; Evidence Level: Grade B) […] Following discussion of the risks, benefits, and alternatives, clinicians may prescribe antibiotic prophylaxis to decrease the risk of future UTIs in women of all ages previously diagnosed with UTIs. (Conditional Recommendation; Evidence Level: Grade B)

• #35 Recurrent UTIs and cystitis symptoms in women

  https://www1.racgp.org.au/ajgp/2021/april/recurrent-utis-and-cystitis-symptoms-in-women

  Antibiotic prophylaxis is a highly effective way of managing rUTIs. […] The choice of antibiotic should be based on confirmed urine culture and sensitivity results wherever possible, regional antibiotic resistance patterns as well as patient preferences and tolerance. […] Vaginal oestrogen helps reduce the rate of rUTIs. […] The use of topical vaginal oestrogen in postmenopausal women helps reduce the rate of rUTIs. […] D-mannose is thought to have an antibacterial activity by inhibiting the adherence of bacteria to urothelial cells and has been shown in limited randomised prophylaxis trials to reduce with the rate of UTI recurrence in women. […] Vaccines against urinary tract bacteria have shown variable efficacy. […] Women with rUTIs benefit from the use of non-antibiotic measures to prevent infection as well as the considered use of antibiotic prophylaxis.

• #36 What doctors wish patients knew about UTI prevention | American Medical Association

  https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-uti-prevention

  Holding your urine can definitely increase your risk for a lot of different issues, said Dr. Bryan. And a urinary tract infection is one of those. […] The biggest thing for prevention is drinking a lot of water, said Dr. Steers. […] Postmenopausal women who have a lot of vaginal atrophythinning, drying and inflammation of the vaginal walls that may occur when your body has less estrogenmight need other forms of prevention, Dr. Steers said. […] General overall health is so important. If youve got other medical conditions, tend to those, Dr. Bryan said.

• #37 Antibiotic prophylaxis for urinary tract infection | The College of Family Physicians of Canada

  https://www.cfp.ca/content/68/12/896

  Interventions include dosing daily (eg, 40 mg TMP and 200 mg SMX, or 100 mg TMP), 3 times per week (eg, 40 mg TMP and 200 mg SMX), or every 10 days (3 g fosfomycin). The optimal prophylaxis regimen is unclear. A reasonable trial of prophylaxis may be 6 months. Alternative interventions include increasing fluid intake by 1.5 L per day in those with lower baseline fluid intake, which is associated with approximately 1.5 fewer UTIs and antibiotic prescriptions per person at 1 year. Similarly, vaginal estrogen (ring or cream) may reduce the risk of recurrent UTIs in postmenopausal women (by 34% to 61% vs 72% to 94% placebo at 6 months).

• #38 Urinary Tract Infections in Pregnant Individuals | ACOG

  https://www.acog.org/clinical/clinical-guidance/clinical-consensus/articles/2023/08/urinary-tract-infections-in-pregnant-individuals

  Urinary tract infection (UTI) is one of the more common perinatal complications, affecting approximately 8% of pregnancies. Screening for and treating asymptomatic bacteriuria have been shown in multiple studies to reduce the incidence of pyelonephritis in pregnancy. […] Screening for ASB has become accepted clinical practice to prevent pyelonephritis in pregnancy. However, the studies supporting ASB screening were mostly performed in the 1960s and 1970s, study quality is poor, and the antibiotic-treatment regimens do not reflect contemporary practice. […] Clinicians should screen for ASB with a urine culture once at a visit early in prenatal care. There is insufficient evidence to recommend for or against repeat screening during pregnancy after a negative initial culture result. […] Clinicians should prescribe a 5-7 day course of targeted antibiotics to treat ASB with colony counts of 100,000 CFU/mL or higher. There is insufficient evidence to recommend for or against repeat screening after appropriate treatment of an initial episode of ASB.

• #39 Urinary Tract Infections in Pregnant Individuals | ACOG

  https://www.acog.org/clinical/clinical-guidance/clinical-consensus/articles/2023/08/urinary-tract-infections-in-pregnant-individuals

  After treating a recurrent acute infection, clinicians may consider initiating antimicrobial urinary suppression for the remainder of the pregnancy, preferably using a lower single daily dose of an antibacterial drug to which the bacterium isolated was susceptible. […] There is insufficient evidence to guide management after treatment of pyelonephritis in pregnancy. Clinicians may consider suppressive therapy for the remainder of the pregnancy, as for recurrent UTI.

• #40 Preventing Urinary Tract Infections in Children | NYU Langone Health

  https://nyulangone.org/conditions/urinary-tract-infections-in-children/prevention

  Many childhood urinary tract infections (UTIs) are caused by poor hygiene, straining or hesitancy while urinating, or difficulty relaxing the muscles of the bladder and urethra. UTIs can also occur in children who hold in urine for long periods of time or dont drink enough fluids. […] Our experts offer tips to help your child improve his or her bathroom habits and to prevent urinary tract infections: […] Teach children to wipe from front to back, which can help keep the urethrathe tube that carries urine out of the bodyfrom becoming infected with bacteria from the anus. […] Place children on a regular bathroom schedule to ensure that they urinate every two to four hours. […] Ensure that children eat a healthy diet and drink plenty of fluids to flush out bacteria and prevent constipation, which can make it difficult to empty the bladder and may increase the risk of developing a UTI.

• #41 Prophylactic antibiotics for children with recurrent urinary tract infections | Canadian Paediatric Society

  https://cps.ca/documents/position/prophylactic-antibiotics-recurrent-urinary-tract-infections

  Prophylactic antibiotics for urinary tract infections are no longer routinely recommended. […] The vast majority of children receiving UTI prophylaxis do not benefit. There is no evidence that prophylaxis prevents renal scarring or other long-term sequelae. […] Therefore, more harm than benefit may result from prophylaxis. Long-term antibiotics may cause adverse events as well as promote resistance to all available oral antibiotics. […] Antibiotic prophylaxis is no longer routinely recommended after a UTI but may still be considered when a child is known to have a grade IV or V VUR, or a significant urological anomaly. […] An increasing risk for antibiotic resistance may soon negate the benefits of prophylaxis even in these cases. […] Prophylaxis should be stopped or changed if an organism that is resistant to the prophylactic antibiotic is identified in a urine culture, even when the culture is believed to be contaminated. […] Parents of a child who has had a UTI need to be informed of the signs and symptoms of a recurrence. The threshold should be low for testing for a UTI in such children.

• #42 Antibiotic Prophylaxis for the Prevention of Urinary Tract Infections in Children: Guideline and Recommendations from the Emilia-Romagna Pediatric Urinary Tract Infections (UTI-Ped-ER) Study Group

  https://www.mdpi.com/2079-6382/12/6/1040

  Antibiotic prophylaxis for the prevention of urinary tract infections in children: Guideline and recommendations from the Emilia-Romagna Pediatric Urinary Tract Infections (UTI-Ped-ER) Study Group. […] Urinary tract infection (UTI) represents one of the most common infectious diseases and a major cause of antibiotic prescription in the pediatric population. To prevent recurrent infections and long-term complications, low-dose continuous antibiotic prophylaxis (CAP) has been used. However, the efficacy of CAP is controversial. The aim of this document was to develop updated guidelines on the efficacy and safety of CAP to prevent pediatric UTIs. […] The use of CAP is not recommended in children with a previous UTI, with recurrent UTIs, with vesicoureteral reflux (VUR) of any grade, with isolated hydronephrosis, and with neurogenic bladder. CAP is suggested in children with significant obstructive uropathies until surgical correction. Close surveillance based on early diagnosis of UTI episodes and prompt antibiotic therapy is proposed for conditions in which CAP is not recommended.

• #43 Long-term antibiotics for prevention of recurrent urinary tract infection in older adults: systematic review and meta-analysis of randomised trials | BMJ Open

  https://bmjopen.bmj.com/content/7/5/e015233

  Objective To address clinical uncertainties about the effectiveness and safety of long-term antibiotic therapy for preventing recurrent urinary tract infections (UTIs) in older adults. […] Findings from three small trials with relatively short follow-up periods suggest long-term antibiotic therapy reduces the risk of recurrence in postmenopausal women with recurrent UTI. […] We did not identify any evidence to inform several clinically important scenarios including, benefits and harms in older men or frail care home residents, optimal duration of prophylaxis, recurrence rates once prophylaxis stops and effects on urinary antibiotic resistance. […] Older men and women are commonly prescribed long-term antibiotics to prevent recurrent urinary tract infection (UTI). […] There are several important clinical uncertainties relating to long-term antibiotic use in older adults with recurrent UTI, including effect on frequency of infective episodes, optimal duration of prophylaxis, adverse effects, risk of relapse following cessation of prophylaxis and effect on urinary antibiotic resistance.

• #44 Urinary Tract Infection Prophylaxis Among Older Adults Increase Risks – Infectious Disease Advisor

  https://www.infectiousdiseaseadvisor.com/news/uti-prophylaxis-associated-with-antibiotic-resistance-hospitalization-infection-sepsis/

  Long-term antibiotic urinary tract infection (UTI) prophylaxis is associated with an increased risk of antibiotic resistance, hospitalization or emergency department visits, bloodstream infection, and sepsis among older adults aged 66 years or older, according to a retrospective cohort study published in Clinical Infectious Diseases. […] This study found no clinical benefit of antibiotic prophylaxis for UTI among older adults; however, it demonstrated the increased risk of harm associated with prophylaxis, most notably the development of antibiotic resistance. […] Our findings may help to highlight some of the risks of UTI prophylaxis in older adults which could shift clinicians understanding of the ratio between benefits and harms in this population, study authors concluded.

• #45 Urinary Tract Infections — Nonantibiotic Prophylaxis With High-Dose Cranberry Proanthocyanidins – Today’s Geriatric Medicine

  https://www.todaysgeriatricmedicine.com/archive/ND19p10.shtml

  Robust science and clinical guidelines support 36 mg cranberry proanthocyanidins as an intervention to prevent recurrent urinary tract infections and drive optimal antibiotic stewardship efforts. […] As the population ages, the overall UTI burden will go up too, requiring new approaches and multidisciplinary strategies to improve the diagnosis, treatment, and, most key, prevention strategies to optimize elder care. […] In its recently published guidelines for the management of recurrent UTIs, the American Urological Association highlights the use of cranberry prophylaxis, citing the benefits of proanthocyanidins (PAC), the bioactive ingredient contained in the fruit. […] A minimum of 36 mg of the PAC ingredient is required to promote bacterial AAA and contribute to UTI prevention. […] Evidence-based cranberry prophylaxis with 36 mg PAC represents an opportunity for a reset in health care providers approach to the management of UTIs.

• #46 Urinary Tract Infections — Nonantibiotic Prophylaxis With High-Dose Cranberry Proanthocyanidins – Today’s Geriatric Medicine

  https://www.todaysgeriatricmedicine.com/archive/ND19p10.shtml

  Incorporating 36 mg PAC into any daily regimen for ongoing UTI prevention can be simple and be a component of a larger UTI strategy focused on driving optimal antibiotic stewardship. […] There are virtually no drawbacks associated with a 36 mg PAC protocol for UTI prophylaxis. […] A pharmaceutical-grade supplement that contains proven effective 36 mg PAC is a tool that can be simply and safely implemented into routine care to prevent recurrent UTIs, thus improving the quality of life for elderly patients.

• #47 Deprescribing UTI prophylaxis

  https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/conditions-and-treatments/urinary/deprescribing-uti-prophylaxis/

  Antibiotic prophylaxis may have been started to prevent recurrent UTIs in a patient under your care. This is mainly a scenario which affects women. There is no evidence of any additional benefit from such prophylaxis beyond 3-6 months. There is significant evidence of harm. […] The patient should be advised upon initiation that antibiotic prophylaxis is prescribed for a fixed period of time, that there is a risk of side effects and that this is not intended to be a long-term medication. […] Patients should be given appropriate advice regarding continuation of simple measures to prevent UTI which may help reduce frequency of UTIs (such as increased fluid intake). There is limited evidence for these interventions but, anecdotally, many patients find them effective. […] The risks of long term antibiotics should be discussed with the patient. These include vulvovaginal candida infections or candida balanitis (thrush), Clostridioides difficile and adverse effects (such as pulmonary fibrosis or peripheral neuropathy with nitrofurantoin).

• #48 Antimicrobial prophylaxis in non pregnant women with recurrent urinary tract infection (UTI) – Primary Care Notebook

  https://primarycarenotebook.com/pages/infectious-disease/antimicrobial-prophylaxis-in-non-pregnant-women-with-recurrent-urinary-tract-infection-uti

  Most authorities advocate a 6-month trial of prophylaxis, with the dose administered at night, after which the regimen is discontinued and the patient observed for further infection. […] 60% of women will develop symptoms within 3-4 months of discontinuation and so will require long term prophylaxis. […] It appears that most women revert back to the earlier pattern of recurrent infections once prophylaxis is stopped unless other factors, such as sexual activity or diaphragm-spermicide use, are modified. Some authorities advocate a longer period of prophylaxis -2 or more years – in women who continue to have symptomatic infections.

• #49 Antibiotic prophylaxis in non-pregnant women with recurrent UTIs – Primary Care Notebook

  https://primarycarenotebook.com/pages/infectious-disease/antibiotic-prophylaxis-in-non-pregnant-women-with-recurrent-utis

  Most authorities advocate a 6-month trial of prophylaxis, with the dose administered at night, after which the regimen is discontinued and the patient observed for further infection. […] 60% of women will develop symptoms within 3-4 months of discontinuation and so will require long term prophylaxis. […] Some authorities advocate a longer period of prophylaxis -2 or more years – in women who continue to have symptomatic infections.

• #50 Recurrent UTI Treatment: What You Need To Know

  https://liveutifree.com/uti-treatment/

  Studies show that once prophylactic treatment is ended, females are likely to return to the same rate of UTI recurrence they experienced before they commenced the treatment. […] For this reason alone, specialists in the area of chronic urinary tract infections do not recommend the use of low dose antibiotic regimens for UTI treatment. […] So while you may find prophylactic antibiotic treatment helpful, there is a good chance your UTIs will return if you cease the treatment, and you may actually be making your condition worse. […] The main difference between this type of UTI treatment, and the continuous prophylactic antibiotic treatment mentioned above, is the dosage. […] Prophylactic doses are low, and are intended to prevent acute episodes. Biofilm treatment doses are high, and are intended to eradicate the infection completely over time.

• #51 Nonantibiotic prevention and management of recurrent urinary tract infection | Nature Reviews Urology

  https://www.nature.com/articles/s41585-018-0106-x

  Urinary tract infections (UTIs) are highly prevalent, lead to considerable patient morbidity, incur large financial costs to health-care systems and are one of the most common reasons for antibiotic use worldwide. […] The growing problem of antimicrobial resistance means that the search for nonantibiotic alternatives for the treatment and prevention of UTI is of critical importance. […] Alternatives to antibiotics for the prevention of recurrent urinary tract infection (UTI) are attractive options to reduce the risks of antimicrobial resistance. […] The most commonly studied nonantibiotic management options for recurrent UTI include cranberries, probiotics, d-mannose, methenamine hippurate, estrogens, intravesical glycosaminoglycans and immunostimulants. […] Evidence for the nonantibiotic measures is hampered by considerable heterogeneity, and further placebo-controlled randomized trials of these agents are needed. […] A combination of these agents might provide the optimal treatment to reduce recurrent UTI, and trials in specific population groups are required.

• #52 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 | Full Text

  https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-018-2998-4

  However, antibiotics are the main driving force in the development of antibiotic resistance and can lead to resistance not only of the causative microorganisms but also of the commensal flora. […] The advisability of using non-antibiotic preventative treatments for rUTI has been highlighted by recent UK, European and US guidelines to reduce the collateral damage of antibiotic use by minimising risk of resistance development. […] A well-designed research study providing robust evidence of at least equivalent effectiveness of non-antibiotic treatment is needed to further inform guideline-writers and policy-makers and allow recommendation of alternative treatments avoiding prolonged antibiotic use. […] The use of effective non-antibiotic UTI prevention strategies will reduce risk to patients of emergence of resistant organisms and subsequent difficult-to-treat clinical infection with these bacteria. […] The study aims to provide high-level contemporary evidence of the relative effectiveness of a non-antibiotic UTI prevention treatment compared to the standard treatment of prolonged, low-dose antibiotics within a UK population of women with rUTI in a routine NHS care setting.

• #53 Management and Prevention of Recurrent Urinary Tract Infections in Women | Consultant360

  https://www.consultant360.com/articles/management-and-prevention-recurrent-urinary-tract-infections-women

  The use of acupuncture for the prevention of recurrent UTIs has shown promise. […] Despite the limited evidence and the amount needed to be taken orally to achieve effective levels, d-mannose could be considered an option for women seeking nonantimicrobial options for the prevention of recurrent UTIs. […] A recent Cochrane review found that methenamine hippurate might be effective for preventing UTIs in patients without renal tract abnormalities, particularly when used for short-term prophylaxis. […] OM-89 significantly reduced the rate of UTI recurrence, and the mean number of UTIs in women taking OM-89 was approximately 50% lower than the number in the placebo group. […] A vaginal vaccine, Urovac, contains 10 heat-killed uropathogenic bacteria, including 6 strains of E coli and 1 strain each of Proteus vulgaris, K pneumoniae, Morganella morganii, and Enterococcus faecalis.

• #54 Treatment and Prevention of Urinary Tract Infection

  https://www.urology-textbook.com/urinary-tract-infection-treatment.html

  Non-pharmacological Prevention of Urinary Tract Infections […] The increase of fluid intake (water) and thus the diuresis to about 1.52 l prevents UTIs. […] An additional preventive effect can be expected from the consumption of fruit juices from berries and dairy products with probiotic bacteria. […] Regular consumption of cranberry juice or concentrate (twice daily) reduces the frequency of urinary tract infections (RR 0.6). […] Hygiene measures can damage the vitality of lactobacilli in the vagina. […] Urinary tract infections can be prevented by micturition immediately after sexual intercourse, avoiding anal intercourse, and avoiding using diaphragm or spermicides. […] Oral vaccination with inactivated but immunogenic E. coli strains (e.g., Uro-Vaxom in a single daily dose for three months) shows a protective effect, reduction of the recurrence rate by 2265% over 612 months.

• #55 Urinary Tract Infections – Whole Health Library

  https://www.va.gov/WHOLEHEALTHLIBRARY/tools/urinary-tract-infections.asp

  Urinary tract infections (UTIs) are some of the most common infections seen in the primary care setting. […] Simple, low risk interventions to reduce these risks include urination after intercourse, avoiding holding urine/waiting a long time to urinate after the urge arises, and, for women, wiping from front to back after urination. […] There has been some conflicting evidence around the efficacy of cranberry for adjunctive treatment or prevention of urinary tract infections. […] The gut is lined with beneficial bacteria that aid in digestion and maintain a healthy gut. […] There is some evidence that vitamin C can decrease a person’s risk of developing urinary tract infections. […] There is some evidence that acupuncture can reduce recurrence rate of UTIs and reduced urine retained in the bladder after urination. […] Methenamine hippurate exhibits antibacterial activity by the conversion of methenamine to formaldehyde in the presence of acidic urine, thus offering a nonantibiotic medication for prophylaxis in those at risk for recurrent UTIs.

• #56 What to do about recurrent urinary tract infections: A review of evidence behind emerging therapies

  https://www1.racgp.org.au/ajgp/2024/may/what-to-do-about-recurrent-urinary-tract-infection

  Recurrent urinary tract infections require investigation and risk factor identification. […] Appropriate patient education in the primary care setting, behavioural modifications and commencement of non-antibiotic treatment might reduce rUTI. […] Most guidelines encourage increasing fluid intake to greater than 1.5 L/day to reduce the number of UTIs and subsequent antibiotic treatment required. […] Other behaviours to reduce risk factors for rUTIs include wiping from front to back after defecation and post-coital urination, which are thought to help by reducing female periurethral colonisation. […] Second-line treatment for rUTIs include non-antimicrobial prophylaxis; these can be used according to the suggested treatment guideline. […] Prevention of future episodes with antibiotic prophylaxis is supported by all guidelines and needs to be offered to those patients suffering from rUTIs. […] Although antibiotic prophylaxis can control rUTIs, proper patient education about preventive measures such as behavioural modifications are necessary to reduce rUTIs, along with simple non-antibiotic measures.

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