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A Review of Nonantibiotic Agents to Prevent Urinary Tract Infections in Older Women

  • Christian M. Gill
    Affiliations
    Henry Ford Hospital, Department of Pharmacy, Detroit, MI
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  • Maria-Stephanie A. Hughes
    Affiliations
    University of Rhode Island, Department of Pharmacy Practice, College of Pharmacy, Kingston, RI

    Veterans Affairs Medical Center, Infectious Diseases Research Program, Providence, RI
    Search for articles by this author
  • Kerry L. LaPlante
    Correspondence
    Address correspondence to Kerry L. LaPlante, PharmD, FCCP, FIDSA, Professor, University of Rhode Island, College of Pharmacy, 7 Greenhouse Rd, Suite 295A, Kingston, RI 02881.
    Affiliations
    University of Rhode Island, Department of Pharmacy Practice, College of Pharmacy, Kingston, RI

    Veterans Affairs Medical Center, Infectious Diseases Research Program, Providence, RI

    Warren Alpert Medical School of Brown University, Division of Infectious Diseases, Providence, RI
    Search for articles by this author

      Abstract

      Objective

      This article provides a comprehensive literature review on nonantibiotic agents used for the prevention of urinary tract infections (UTIs) in women ≥45 years of age.

      Design

      A structured review was performed by conducting a literature search to identify relevant studies pertaining to the use of nonantibiotic agents to prevent UTIs in women who were perimenopausal through postmenopausal. Recommendations were made for or against the use of each nonantibiotic agent, unless data were unavailable. Levels of evidence were assigned to each recommendation made.

      Setting and participants

      Studies on the prevention of UTIs with women subjects ≥45 years of age in the community, inpatient, and long-term care settings were considered for inclusion.

      Measure

      The efficacy and safety of using ascorbic acid, cranberry products, d-mannose, estrogens, lactobacilli, and methenamine hippurate for prevention of UTIs was assessed.

      Results

      There is evidence to support use of estrogens (A-I) in postmenopausal women, and cranberry capsules (C-I) in women ≥45 years of age for the prevention of UTIs. There was a lack of evidence to make recommendations for or against the use of ascorbic acid, cranberry juice, cranberry capsules with high proanthocyanidin (PAC) content, d-mannose, lactobacillus, and methenamine hippurate in this population.

      Conclusions/Implications

      Current studies support that estrogens and cranberry capsules may have a role in preventing UTIs in women ≥45 years of age. Further research is needed to elucidate the role of these nonantibiotic agents and how they may be used to decrease antibiotic use.

      Keywords

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