Intended for healthcare professionals

Clinical Review

Diagnosis and management of recurrent urinary tract infections in non-pregnant women

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f3140 (Published 29 May 2013) Cite this as: BMJ 2013;346:f3140

Re: Diagnosis and management of recurrent urinary tract infections in non-pregnant women

In terms of "nonantibiotic options", two other preventative strategies are of proven benefit. The first is immunoactive prophylaxis; a meta-analysis by Naber et al. (1), revealed that an oral immunostimulant (OM-89) reduced the number of UTIs by an average of 39%.

The second is replacement of the glycosaminoglycan (GAG) layer in the bladder; intravesical instillation of agents such as hyaluronic acid have been shown to reduce the UTI frequency rate by up to 77% compared to placebo. (2) Such agents tend to be used when other prophylactic measures have failed.

1. Naber KG, Cho YH, Matsumoto T, Schaeffer AJ. Immunoactive prophylaxis of recurrent urinary tract infections: a meta-analysis. Int J Antimicrob Agents. 2009 Feb;33(2):111-9.
2. Damiano R, Cicione A. The role of sodium hyaluronate and sodium chondroitin sulphate in the management of bladder disease. Ther Adv Urol. 2011 Oct;3(5):223-32.

Competing interests: No competing interests

20 June 2013
Jonathan D Gill
Speciality Registrar in Urology
Pinderfields General Hospital
Aberford Road, Wakefield, WF1 4DG