Primary prevention
High-quality evidence is limited, but measures to reduce the risk of infection may include:[29]
Post-coital urination
Wiping from front-to-back
Increased water intake
Use of probiotics
Use of non-barrier contraception
Avoidance of spermicide
In post-menopausal women, oestrogen levels decline leading to vaginal atrophy and increased risk of recurrent UTI. Vaginal oestrogen replacement may potentially reduce risk of recurrent UTI in post-menopausal women. Evidence is strongest for topical oestrogen in the form of a cream or pessary.
Secondary prevention
Patients with chronic recurrent urinary tract infections (UTIs) and no urological abnormalities upon evaluation, are offered antibiotic prophylaxis (trimethoprim/sulfamethoxazole or nitrofurantoin) taken either daily or post-coitally. Caution should be applied when using nitrofurantoin long-term due to the risk of lung injury.[49]
Urination after coitus, increased water intake, and a course of probiotics may also be beneficial in preventing recurrent cystitis; however, high-quality evidence is limited.[29]
Methenamine hippurate may be non-inferior to antibiotic prophylaxis; however, further studies are recommended.[50][51]
One systematic review and meta-analysis of randomised and quasi-randomised trials Studies done with daily found that daily high doses of cranberry, often in the form of pills or concentrates, show reduced rates of symptomatic, culture-verified UTIs in non-pregnant women with recurrent UTIs (and no underlying urological abnormality).[52] Cranberry products may be recommended for recurrent UTI prevention; however, there is no clear clinical evidence regarding the appropriate dose and treatment duration.[1]
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