The edition · Family Medicine
Recurrent UTIs: three non-antibiotic options have systematic-review support
A BJGP overview of 27 systematic reviews sorts what prevents recurrent urinary infections in women without antibiotics. Also today: the discharge-letter actions that go missing in general practice, and what social prescribing did for diabetes prevention.
The edition in brief
An overview of 27 systematic reviews, published in the British Journal of General Practice on 19 October, found support for cranberry products, methenamine hippurate and, in postmenopausal women, vaginal oestrogen for preventing recurrent urinary tract infections; probiotics, D-mannose, herbal remedies, acupuncture and vaccines need stronger evidence, and more fluid helps women whose intake is low. A record review of 263 patients aged 65 or over discharged from hospital to seven English practices found 551 requested actions in discharge summaries; 20.6% of patients needing an action experienced an error and 4.4% harm, falling hardest on those with dementia or a carer. Using national English primary care data on 2.3 million adults at high risk of type 2 diabetes, social prescribing reached people with more social and mental health need, and its association with diabetes risk shifted from harmful in 2019 to protective by 2023 and after three or more years — an observational signal without activity data.
One in five older patients needing a discharge action met an error in general practice
Treat each discharge summary as a task list, and track every requested action to completion, starting with patients with dementia.
Social prescribing reached those in greatest need, and its diabetes signal turned protective over time
Consider linking high-risk patients to sustained community activity alongside advice, and expect any benefit to take years.
Bacteria in the urine of an older person is not a urinary infection
Do not test or treat urine in older adults without urinary symptoms or sepsis; look for another cause of confusion.
Preventing recurrent UTIs without antibiotics: cranberry, methenamine and vaginal oestrogen
For recurrent UTIs in women, consider vaginal oestrogen after menopause, cranberry or methenamine before reaching for antibiotic prophylaxis.
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