EvidenceAlerts

BACKGROUND: Recurrent urinary tract infections (rUTIs), that is, =2 urinary tract infections (UTIs) in the past 6 months or =3 in the past 12 months, are common, have a substantial impact on quality of life, and cause major antibiotic use.

AIM: To identify non-antibiotic interventions for prevention of rUTIs that have been assessed in systematic reviews, exploring their effectiveness, acceptability, and adherence.

DESIGN AND SETTING: An overview of systematic reviews of randomised controlled trials (RCTs) on non-pharmaceutical and pharmaceutical (non-antibiotic) interventions for preventing rUTIs in women.

METHOD: Medline, Embase, CINAHL, Google Scholar, and Cochrane from January 2014 to May 2025 were searched for systematic reviews of RCTs assessing the effectiveness of community-based non-antibiotic interventions for preventing UTI in women aged =16 years with rUTIs. Studies in intensive care units, relating to people with indwelling catheters, or comparing different oral antibiotic regimens were excluded. There were no limitations regarding outcome measures or language.

RESULTS: In total, 27 systematic reviews met inclusion criteria evaluating probiotics (n = 9), D-mannose (n = 7), vaginal oestrogen (n = 7), cranberry (n = 6), methenamine hippurate (n = 3), herbal medicine (n = 3), increased fluid intake (n = 2), systemic oestrogen (n = 4), acupuncture (n = 2), and vaccines (n = 2). Eight examined combination strategies. Cranberry and methenamine hippurate use are supported by systematic reviews, as is vaginal oestrogen among postmenopausal women, although questions remain around dose, duration, and treatment adherence. Reviews of probiotics, D-mannose, herbal medicine, acupuncture, and vaccines concluded that stronger evidence is needed. Increased fluid intake benefits women with low intake, but further research is needed on optimal intake. There was little information on treatment adherence or acceptability for many interventions.

CONCLUSION: For effective interventions, questions remain about promoting adherence (vaginal oestrogen), or optimal preparation (cranberry), or duration (methenamine). For other interventions a stronger evidence base is needed.

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