Urinary tract infections (UTIs) are highly prevalent, lead to considerable patient morbidity, incur large financial costs to health-care systems and are one of the most common reasons for antibiotic use worldwide. The growing problem of antimicrobial resistance means that the search for nonantibiotic alternatives for the treatment and prevention of UTI is of critical importance. Potential nonantibiotic measures and treatments for UTIs include behavioural changes, dietary supplementation (such as Chinese herbal medicines and cranberry products), NSAIDs, probiotics, d-mannose, methenamine hippurate, estrogens, intravesical glycosaminoglycans, immunostimulants, vaccines and inoculation with less-pathogenic bacteria. Some of the results of trials of these approaches are promising; however, high-level evidence is required before firm recommendations for their use can be made. A combination of these agents might provide the optimal treatment to reduce recurrent UTI, and trials in specific population groups are required.
Rising rates of antimicrobial resistance, fuelled by the overuse of antibiotics in humans, are a serious threat to global public health.
Alternatives to antibiotics for the prevention of recurrent urinary tract infection (UTI) are attractive options to reduce the risks of antimicrobial resistance.
The most commonly studied nonantibiotic management options for recurrent UTI include cranberries, probiotics, d-mannose, methenamine hippurate, estrogens, intravesical glycosaminoglycans and immunostimulants.
Studies of novel vaccines targeting the adherence mechanisms of uropathogenic bacteria seem promising, but human trials are required to determine the efficacy of this approach.
Evidence for the nonantibiotic measures is hampered by considerable heterogeneity, and further placebo-controlled randomized trials of these agents are needed.
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Nature Reviews Urology thanks T. J. Hannan, F. Wagenlehner and the other anonymous reviewer(s) for their contribution to the peer review of this work.
N.S., A.G. and R.Z. declare no competing interests. A.S. has received an unrestricted educational grant, is an adviser to and has received speaker fees from Allergan Ltd. and has received monies from Medtronic for promotional purposes. S.M. has received monies from Medtronic for promotional purposes.
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Sihra, N., Goodman, A., Zakri, R. et al. Nonantibiotic prevention and management of recurrent urinary tract infection. Nat Rev Urol 15, 750–776 (2018). https://doi.org/10.1038/s41585-018-0106-x
World Journal of Urology (2020)
Journal of Applied Microbiology (2019)
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