Non-antibiotic treatment options for preventing recurrent UTIs

This study examined preventative treatment options for recurrent urinary tract infections (UTIs) that do not involve antibiotics.

A UTI is a bacterial infection that affects part of the urinary tract (consisting of the bladder and the urethra). It has been estimated that 20 to 30% of women with a UTI will have a recurrence. Recurrent UTIs are defined as at least 3 UTI episodes in 12 months, or at least 2 episodes in 6 months.

Antibiotics are drugs that destroy or slow down the growth of bacteria. These can be given as a prophylaxis (treatment intended to prevent a disease from occurring) to reduce the chance of UTI recurrence. However, the effectiveness of antibiotics reduces over time. The body can eventually become resistant to antibiotic treatment. Antibiotics are also associated with a number of side effects. There is a growing need for alternative prophylactic treatment for recurrent UTIs.

The aim of this study was to review current evidence on non-antibiotic prophylaxis for UTIs.

Healthy bacteria in the vagina (vaginal flora) play an important role in UTI occurrence. Women after menopause who take estrogen (female sex hormone) by vaginal administration can significantly improve vaginal flora. One study involving 60 postmenopausal women with recurrent UTI reported an average of 0.5 episodes of UTI per year with vaginal estrogen treatment. This was significantly lower than the average of 5.9 UTIs for women receiving placebo (control drug with no active effect). Another study reported similar findings, with the number of UTIs reduced by about one third. Importantly, estrogens taken orally do not have the same effect and are often associated with serious side effects.

Vaginal suppositories that directly contain healthy bacteria can also improve vaginal flora. Two separate studies found that they were not better than placebo in preventing UTIs in young women. However, another study reported a 50% reduced risk of UTI with a different strain of healthy bacteria. A separate study reported oral treatment with healthy bacteria to be as effective as prophylactic antibiotic treatment. UTI episodes were reduced by about one half. However, patients undergoing antibiotic treatment eventually showed resistance to treatment.

Evidence regarding the effectiveness of vitamin C supplements in improving vaginal flora is mixed. One trial involving 100 pregnant women reported a reduced incidence of UTI from 29.1% to 12.7% with 3 months of vitamin C treatment. However, the quality of evidence is considered low.

In a review of 10 separate studies, cranberry products were found to reduce the incidence of UTI at 12 months by 35%. One study reported a similar advantage with cranberry products compared to prophylactic antibiotic treatment. Another study reported cranberry products to be slightly less effective than antibiotics. However, the rate of side effects was higher with antibiotic treatment.

D-Mannose is another nutritional supplement that has recently emerged for the treatment of UTI. One study involving 308 women with recurrent UTI found that 6 months of D-Mannose supplementation reduced UTI incidence rate to 15%. This was significantly lower than the incidence rate of 60% with placebo. Further clinical trials are needed.

Vaccinations can help stimulate the body’s immune system to fight the bacterial infections that cause UTIs. OM-89 (an oral vaccination) was found to reduce the risk of UTI by 39% compared to placebo in an analysis of 4 separate studies. In 3 separate studies involving 220 women, Urovac (a vaginal vaccination) was associated with a significantly prolonged time to the first recurrence. More clinical trials testing vaccinations for UTIs are needed.

Acupuncture involves the stimulation of certain points on the body through the placement of thin needles. It is often used in the management of chronic pain. Acupuncture is being examined in two studies as a method of preventing recurring UTI. Preliminary results show a 52% reduction in the rate of UTI compared to a sham treatment. However, further studies are needed.

Researchers reported good effectiveness for estrogen replacement therapy in women after menopause. The application of healthy bacteria as well as cranberry products can be considered as an alternative to prophylactic antibiotics. Vitamin C was not recommended to prevent UTI recurrences. More studies are needed to examining D-Mannose, acupuncture, and vaccination.