Various nonantibiotic prophylaxis options are available, some of which may be beneficial for adults with recurrent urinary tract infections, according to a review and meta-analysis published in The Journal of Urology.
Mariëlle A.J. Beerepoot, M.D., from the Academic Medical Center in Amsterdam, and colleagues reviewed the literature to assess the effectiveness, tolerability, and safety of nonantibiotic prophylaxis in adults with recurrent urinary tract infections. Data were included from 17 studies for 2,165 patients.
The researchers found that the rate of urinary tract infection recurrence was decreased with use of the oral immunostimulant OM-89 (four trials; risk ratio, 0.61), with a good safety profile. The recurrence of urinary tract infections was slightly reduced with the vaginal vaccine Urovac (three trials; relative risk, 0.81), and the time to reinfection was increased with primary immunization followed by booster immunization.
There was a trend toward preventing urinary tract infections with vaginal estrogens (two trials; relative risk, 0.42; 95 percent confidence interval, 0.16 to 1.10), but in 6 to 20 percent of women, vaginal irritation occurred. Recurrence was also decreased with cranberries (two trials; relative risk, 0.53) and acupuncture (two open-label trials; relative risk, 0.48). The rate of recurrence was not decreased with oral estrogens and lactobacilli prophylaxis.
“The evidence of the effectiveness of the oral immunostimulant OM-89 is promising,” the authors write. “Large head-to-head trials should be performed to optimally inform clinical decision making.”
Some of the studies included in the review were funded by manufacturers.