- Design
- Overview of 27 systematic reviews of randomised trials
- Population
- Women aged ≥16 with recurrent urinary tract infection
- Primary outcome
- Effectiveness of non-antibiotic preventive interventions
- Effect
- Supported: cranberry, methenamine hippurate, vaginal oestrogen (postmenopausal); others unproven
An overview in BJGP drew together 27 systematic reviews of randomised trials of non-antibiotic prevention of recurrent UTI in women aged 16 and over, defined as two or more infections in six months or three or more in a year.
Three interventions were supported by systematic reviews: cranberry products, methenamine hippurate, and vaginal oestrogen in postmenopausal women. Increased fluid intake helped women who drank little. For probiotics, D-mannose, herbal medicines, acupuncture and vaccines, the reviews concluded that the evidence was not yet strong enough. Questions remain about the best cranberry preparation, how long to use methenamine and how to help women keep using vaginal oestrogen.
Recurrent UTI is a major driver of long-term antibiotic prescribing in primary care. Having a short list of evidence-based non-antibiotic options makes it easier to offer one before, or instead of, prophylactic antibiotics.
Discuss these with women who have recurrent UTI, matching the choice to menopausal status and preference. D-mannose is widely sold and often asked about; it is reasonable to say the evidence is not yet convincing.
- Confirm recurrent UTI: two or more in six months, or three or more in a year
- Offer vaginal oestrogen to postmenopausal women with recurrent UTI
- Consider methenamine hippurate or cranberry products as non-antibiotic options
- Ask about fluid intake and advise more for women who drink little
- Tell women that D-mannose and probiotics are not yet proven, if they ask
Why it matters
It gives family physicians evidence-based alternatives to prophylactic antibiotics.
Don't overread it
This overview did not pool effect sizes, so it does not say how much each option reduces infections.
The statistics, in plain English
An overview of reviews summarises what earlier systematic reviews concluded; it is a map of the evidence, not a new estimate of benefit.
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