The American College of Physicians (ACP) has unveiled a new guideline for preventing recurrent kidney stones in adults.

For patients who have had 1 or more prior kidney stone episodes, the guideline recommends increased fluid intake spread throughout the day to achieve at least 2 liters of urine per day.

The guideline also recommends pharmacologic monotherapy with a thiazide diuretic, citrate, or allopurinol to prevent nephrolithiasis in patients with active disease in which increased fluid intake fails to reduce stone formation.

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In addition, according to the guideline, which was published in Annals of Internal Medicine (2014;161:659–667), evidence shows that patients who decreased intake of soda acidified by phosphoric acid had decreased kidney stone recurrence.

“Clinicians should encourage patients to avoid colas as opposed to fruit-flavored soft drinks, which are often acidified by citric acid,” the guideline stated.

The guideline, developed by the ACP’s Clinical Guidelines Committee, is based on a systemic evidence review and an evidence report sponsored by the U.S. Agency for Healthcare Research and Quality.