Urinary tract infections (UTI) are among the most prevalent bacterial infections in both inpatient and outpatient facilities. They affect about 150 million people annually. About 1 in 7 women suffers at least one infection per year. About a third of those women develop another UTI 6-12 months after the first infection. There are many ways to prevent recurring urinary tract infections. The prevalence of bacteriuria (a common feature in UTI) for those over the age of 60 is significantly higher in women than men. Nearly 20-30% of women with an infection experience recurrence. High risk populations for UTI include pregnancy, elderly, children, people with an indwelling catheter and those with a neurogenic bladder. Frequent sexual intercourse increases recurrence rate of UTI’s. Abstinence when having an infection will improve recovery and urinating immediately after coitus is recommended along with the higher intake of water.
A recurrent UTI is classified as having 2 symptomatic episodes within the last 6 months or if 3 episodes have occurred within the last 12 months. There are many approaches to reducing the recurrence rate of urinary tract infections. Non-antibiotic choices are best because they are easily managed but also because it prevents the development of resistance and the corresponding adverse reactions of antibiotics. Here are 6 ways to prevent urinary tract infections:
- Drink sufficient fluids: The rule of thumb is to drink 1/2 your body weight in ounces. So if you weight 140 pounds, then you should drink about 70 ounces of water per day. Of course certain diuretics such as caffeine and alcohol, require adjustment of those numbers as well as exercise so that may mean close to 85 ounces/day. If you are prone to re-infection, caffeine and alcohol should be limited since they can irritate the bladder wall and cause dehydration.
- Cranberries (Vaccinium macrocarpon): originated in New Zealand and is loaded with phytochemical compounds such as proanthocyanidins (PACs), anthocyanin, benzoic acid and ursolic acid. Escherichia coli (E.coli is a primary pathogen in UTI’s) is prevented from adhering from the uroepithelial cells by PACs contained in cranberries in the urinary tract. Even though studies on long-term prevention using cranberry products have been inconsistent, I still recommend them since they are safe (especially in children), easy to use in an extract capsule form or drink, and clinically effective in many of my patients.
- D-mannose: This is a simple sugar, or monosaccharide found in many fruits. Small clinical studies suggest that oral D-mannose may reduce UTI recurrence, when used alone or when in combination with other ingredients (cranberry extract, tara gum and probiotic bacteria 1-2.5 billion live cells of L. planetarum, L paracasei and Strep thermophilus). It also inhibits E. Coli bacteria from binding to the bladder wall. In one study, the intake of 2 gms of D-mannose dissolved in a glass of water every day showed a significant drop of urinary tract infections compared with placebo.
- Uro-Vaxom is an immune-stumulant agent with bacterial cell wall components from the strains of E.Coli. Uro-Vaxom caps. In 2 meta studies, the recurrence rate was reduced by 39% compared to placebo. There was a significant reduction from treatment time to breakthrough infections. Uro-Vaxom trial
- Estradiol or Estriol vaginal cream for postmenopausal women. This treatment serves as therapy for vaginal atrophy and reduces both colonization with uropathogens and also balances the vaginal PH to reduce risk of vaginal bacterial infections.
- Antibiotic therapy should only be used when all other options have failed. When choosing an antibiotic, make sure a urine culture has been done to choose the right antibiotic and avoid resistance. Single dose postcoital antibiotic prevention is a good prevention especially for women in whom a correlation between recurrent UTI’s and sexual intercourse has been suspected.
References: Hertlein, A. Recurrent Urinary Tract Infections: What’s Good Prophylaxis? Medscape, Oct 31, 2022.
Magasi, P, et al. Uro-Vaxom and the management of recurrent urinary tract infection in adults: a randomized multi center double-blind trial. Euro Urol, pubmed.ncbi.nim.nih.gov. 1994
Hisano, M, Bruschini, H et al. Cranberries and lower urinary tract infection prevention. Sao paulo clinic. 2012 Jun 67 (6): 661-667