Other rUTI treatment options
Other rUTI treatment options
Alternative options to antibiotic treatment include:9,14
- Non-antibiotic treatments, including topical oestrogens, methenamine hippurate and immunostimulants
- Non-pharmacological options, such as D-mannose, cranberry, probiotics, manuka honey and acupuncture
- Specialist options, such as intravesical antibiotics or intravesical glycosaminoglycan (GAG) layer replacement
These options should be considered in all eligible patients; they are important as:
Professor Dame Sally Davies, Former UK Chief Medical OfficerWE HAVE REACHED A CRITICAL POINT AND MUST ACT NOW ON A GLOBAL SCALE TO SLOW DOWN ANTIMICROBIAL RESISTANCE.
TREATMENTS
OPTIONS
Oestrogen deficiency is a risk factor for rUTIs. Topical oestrogen may protect against UTIs, although vaginal oestrogen products are not licensed for the prevention of rUTIs.9
It has been suggested that methenamine hippurate has similar efficacy to antibiotic prophylaxis and that it reduces symptomatic UTIs with short-term use.9
Immunostimulants, rather than true vaccines, have also been shown to reduce rUTIs.9
Other products that may prevent rUTIs include D-mannose or cranberry products. These contain sugar and so may not be suitable for everyone. A small study has shown that D-mannose is as effective as nitrofurantoin in preventing rUTIs.9 Cranberry products are not recommended by NICE4 and should not be taken by anyone on warfarin treatment.8
There is inconclusive evidence about whether probiotics (lactobacilli) or manuka honey14 reduce the risk of UTIs in people with recurrent infections, but small studies have shown that acupuncture reduce episodes of UTIs compared with no treatment.9
Intravesical antibiotics, including gentamicin and amikacin, have been used in specialist centres, with some anecdotal reports of being effective in some patients.9
Intravesical glycosaminoglycan (GAG) layer replacement therapy is an option to temporarily replenish the GAG layer18 which may become damaged due to recurrent UTIs. This is discussed in more detail on the following screen.