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Non-antibiotic alternatives to preventing urinary tract infections

Diagnosis and management of UTIs and rUTIs

Current standard treatment of UTIs

Potential issues with antibiotic treatment

Antimicrobial stewardship

Other rUTI treatment options

GAG layer replacement

GAG layer replacement therapy

Your role in supporting patients with rUTIs

Assessment questions

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module menu icon GAG layer replacement therapy

GAG layer replacement therapy

HANDLING

Products for intravesical instillation of GAG layer replacement therapy are classified as medical devices, with a sterile solution presented in a prefilled syringe or in a vial.18 The solution is administered via a catheter or special adapter. Standard procedures should be undertaken to reduce the risk of infection and contamination during administration.

SIDE EFFECTS

These products are composed of naturally occurring compounds with very low probability to induce an immune response. Side effects are likely to be minimal,21 but treatment should be suspended in the event of the onset of any undesired effect.18

INTERACTIONS

The potential for drug interactions is likely to be minimal.21 No interactions between GAG layer replacement therapy products and other medications are known or have been observed, but there have been no studies undertaken on the use in children, or during pregnancy and lactation.18

CONTRAINDICATIONS

There are no known contraindications deriving from the use of the device apart from hypersensitivity to any of the components.18

What is the evidence for GAG layer replacement therapy?

Various studies have investigated the effectiveness of CS and HA combination GAG layer replacement therapy, with a short summary in the table below:

AUTHOR REDUCING
rUTI RATES		 IMPROVING URINARY
SYMPTOMS		 IMPROVING
QUALITY OF LIFE		 WELL-TOLERATED
Cicione et al19  
Damiano et al22  
De Vita et al23  
De Vita et al24  
Goddard et al25  

Additional findings include:

  • GAG layer replacement therapy with CS and HA was found to be more effective than long-term antibiotic prophylaxis for preventing rUTIs.26
  • The effectiveness of GAG layer replacement therapy was found to improve over time, with an even better expected comparative effectiveness profile in the long run. This is in contrast with the effect of long-term antibiotic prophylaxis, where side effects and the development of resistance are important considerations.27

Non-antibiotic alternatives to preventing urinary tract infections

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