Treating recurrent UTIs without antibiotics

Written by Sophie Grand, a freelancer for Health Lab. 

Urinary tract infections are incredibly widespread, affecting approximately 50% of women and 10% of men at some point in their lives. 

These infections arise when bacteria proliferate in the urinary tract, which includes the bladder, urethra and kidneys. 

Most UTIs originate in the lower urinary tract, where bacteria enter through the urethra and spread up towards the bladder, which can lead to cystitis, a painful infection.

A prominent symptom associated with classic UTIs is urgency—a strong and uncontrollable need to urinate that can’t be delayed. 

Other common symptoms include frequent urination, burning sensations, bladder pain, incontinence, changes in urine odor and a general feeling of unwellness. 

For many, the battle with a UTI doesn’t end with a single infection. 

Patients who struggle with recurrent urinary tract infections are often recommended to consult with a urologist like Anne Cameron, M.D., a recognized expert at the University of Michigan. 

Cameron holds the James Montie M.D. Legacy Professorship of Urology at U-M Medical School, and currently serves as the vice chair of academic affairs and service chief for the Department of Urology at Michigan Medicine.

To be classified as having recurrent UTIs, an individual must experience multiple infections within a defined timeframe—specifically, three or more in a year, or two within a six-month period. 

Recurrent UTIs are not an uncommon issue, affecting around 30% of all women who have had a UTI.

“When patients experience a pattern of recurring infections, it becomes very important to conduct more testing,” Cameron emphasized. 

Treating a UTI

The American Urological Association and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction recommend a straightforward antibiotic approach for treating typical uncomplicated UTIs in women. 

When a patient presents with an acute onset of classic UTI symptoms, but no fever, flank pain, or signs of more serious conditions like a kidney infection, it’s reasonable to begin a short course of antibiotics without waiting for culture results.

One antibiotic option is double-strength trimethoprim-sulfamethoxazole, taken twice a day for three days. 

Alternatively, Cameron often recommends 100 mg of nitrofurantoin, administered twice daily for five days (though it's important to note that this treatment isn’t suitable for individuals with chronic renal failure.)

However, when it comes to treating patients experiencing recurrent UTIs, the approach shifts significantly.

“In these cases, we need to obtain a urine culture before initiating treatment,” said Cameron. 

“This is crucial because the symptoms of recurrent UTIs can overlap with other bladder conditions, such as interstitial cystitis or bladder pain syndrome and those with recurrent UTIs often have resistant organisms.”

When diagnosing a UTI, the process often starts with a dipstick test to check for white cell activity and nitrites. 

A positive result strongly suggests a UTI, while a negative result usually rules it out, negating the need for culture testing. 

If the dipstick comes back positive, it could also indicate irritation rather than an infection. 

Some women experience a rebound in their urinary tract infection even after being prescribed antibiotics, often due to the selection of an ineffective medication. 

This can happen when a urine culture isn’t performed, which is crucial in identifying the specific bacteria causing the infection and pinpointing which antibiotics will be most effective. 

Without this critical step, a woman may receive an antibiotic that either does not eliminate the bacteria or only weakly suppresses it, possibly leading to a return of symptoms.

Certain medical conditions can also complicate antibiotic treatment. 

Even when the correct antibiotic is prescribed, various patient-specific factors can affect its absorption and efficacy. 

Some women are also inherently at higher risk for UTIs due to anatomical factors or medical history. 

Prevention strategies for UTIs

Preventing recurrent UTIs involves a combination of practical strategies that can considerably improve urinary health.

Several risk factors can increase the likelihood of developing UTIs, including not drinking enough liquids, chronic constipation or diarrhea, incomplete bladder emptying, and various bowel issues.

“Typically, I give common sense advice: stay hydrated, urinate after intercourse, don’t do too much hygiene: douching, washing the vagina/vulva with soap is counterproductive – UTIs rarely occur because you are dirty or have hygiene issue, it is bad luck or inherent risk factors,” said Cameron.

Staying well hydrated is essential, as chronic dehydration is a recognized risk factor for recurrent urinary tract infections. Aim to drink two to three liters of water a day. 

Additionally, it’s important to respond promptly to the urge to urinate—holding it in can create more problems.

Maintaining regular bowel movements and incorporating a diet rich in prebiotic foods can also support healthy fecal flora.

Non-antibiotic treatments for UTIs

Beyond antibiotic treatments, non-antibiotic approaches to managing UTIs are increasingly being recognized for their effectiveness in reducing recurrence and supporting overall urinary health.

Cranberry supplements have recently gained attention for their effectiveness in preventing UTIs, particularly among women. 

High quality supplements should contain soluble proanthocyanidins—flavonoids with anti-inflammatory properties—at high concentrations. 

Cameron notes that not all cranberry products are equally effective; powdered cranberry capsules often lack the potency needed to be impactful. 

While some might consider drinking cranberry juice instead of taking a supplement, this approach requires consuming a substantial amount—up to 600-700 calories daily—to achieve the necessary concentration. 

In addition, Cameron commonly prescribes methenamine hippurate. “This prescription antiseptic duo prevents bacteria from reproducing and is well tolerated and doesn’t contribute to antibiotic resistance, unlike classic prophylactic antibiotics.”

Cameron advises exercising caution with taking the popular supplement, D-mannose. 

“While it’s marketed as a sugar pill that prevents bacterial infections, it’s not really effective and it’s costly. And, notably, the American Urological Association has not included D-mannose in its recommendations for UTI prevention.”

A vaccine on the horizon

Numerous injectable vaccines have been launched in the past, yet most have failed to demonstrate a significant reduction in UTI occurrences, often only increasing antibody levels in the bloodstream without impacting infection rates. 

However, recent advancements in vaccine research offer new hope.

Led by J. Curtis Nickel, M.D. of Queen's University, a Canadian team pioneered a sublingual vaccine known as MV140. 

This daily treatment over three months targets the mucosal immune response, essential for combating UTIs. 

The team conducted early trials in Spain and Canada, and yielded impressive results, showing a 60-70% reduction in UTI occurrences. 

Side effects have been minimal, primarily consisting of mild lip tingling and mouth irritation.

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