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Non-Antibiotic Prophylaxis for Recurrent Urinary Tract Infection: A Narrative Review & Clinical Guide for Primary and
Vaki Antoniou1, Bhaskar Somani2
1Department of Urology, Barking Havering and Redbridge NHS Trust, RM7 0AG Essex, UK.
Summary
Non-antibiotic strategies are key for managing recurrent urinary tract infections (rUTIs), reducing antibiotic use and antimicrobial resistance. This review guides primary care implementation of these effective, safe options for men and women.
Area of Science:
- Urology
- Infectious Diseases
- Pharmacology
Background:
- Recurrent urinary tract infections (rUTIs) are prevalent, causing distress and significant antibiotic prescribing in primary care.
- Repeated antibiotic use for rUTIs leads to adverse effects, microbiome disruption, and antimicrobial resistance.
- Current clinical guidelines advocate for non-antibiotic prophylactic strategies in rUTI management.
Purpose of the Study:
- To review contemporary evidence and guidelines on non-antibiotic prophylaxis for rUTI.
- To focus on practical implementation of these strategies in primary care settings.
- To highlight differences in guideline recommendations and identify research gaps.
Main Methods:
- Narrative review synthesizing evidence from EAU, NICE, and AUA guidelines.
- Appraisal of non-antibiotic options (behavioral, methenamine hippurate, estrogen, D-mannose, probiotics, cranberry, immunoactive, intravesical) based on efficacy, safety, tolerability, accessibility, and evidence quality.
- Exploration of the role of general practitioners in diagnosis, management, and referral.
Main Results:
- Various non-antibiotic prophylactic strategies show promise for rUTI management.
- Guidelines present some differences in recommendations, indicating areas for further research.
- General practitioners play a crucial role in initiating non-antibiotic prophylaxis and shared decision-making.
Conclusions:
- Integrating evidence-based non-antibiotic strategies can reduce antibiotic exposure and improve patient outcomes for rUTI.
- Pragmatic clinical tools are provided to aid evidence translation into practice.
- Proactive management of rUTI with non-antibiotic prophylaxis addresses the global challenge of antimicrobial resistance.
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