Non-antibiotic interventions to prevent recurrent urinary tract infections in women: overview of systematic reviews of randomised controlled trials

Background Recurrent urinary tract infections (rUTI), i.e. 2 or more UTIs in last 6 months or 3 or more in last 12 months, are common, have substantial impact on quality of life and cause major antibiotic use. Design Overview of systematic reviews of randomised controlled trials (RCTs) of non-pharmaceutical and pharmaceutical (non-antibiotic) interventions for preventing rUTI in women. Methods We searched MEDLINE, EMBASE, CINAHL, Google Scholar and Cochrane from January 2014 to May 2025 for systematic reviews of RCTs assessing effectiveness of community-based non-antibiotic interventions for preventing UTI in women aged 16 or over with rUTI. We excluded studies in intensive care units, people with indwelling catheters or comparing different oral antibiotic regimens. There were no limitations regarding outcome measures or language. Findings 27 systematic reviews met inclusion criteria evaluating probiotics (9), D-mannose (7), vaginal oestrogen (7), cranberry (6), methenamine hippurate (3), herbal medicine (3), increased fluid intake (2), systemic oestrogen (4), acupuncture (2), vaccines (2). Eight examined combination strategies. Cranberry and methenamine hippurate use are supported by systematic reviews, as is vaginal oestrogen amongst postmenopausal women, although questions remain around dose, duration and treatment adherence. Reviews of probiotics, D-mannose, herbal medicine, acupuncture and vaccines concluded that stronger evidence is needed. Increased fluid intake benefits women with low intake, but further research is needed on optimal intake. There was little information on treatment adherence or acceptability for many interventions. Conclusions For effective interventions, questions remain about optimal use and for many stronger evidence is needed.