Recurrent urinary tract infection (UTI) imposes a heavy burden on health services. By definition recurrent UTI is two infections in six months or three in one year. The annual incidence of single UTI is 30 per 1000 women. The Scottish Intercollegiate Guidelines Network (SIGN) and the European Association of Urology (EAU) recommend the use of low dose prophylactic antibiotics in recurrent UTI. But the side-effect is antibiotic resistance development and the emergence of superbugs such as extended-spectrum beta-lactamases (ESBL), etc. This paper discusses in detail the various non-antibiotic options and their support (or otherwise) from various trials and Cochrane Reviews. The common options are urinary alkalinisation, probiotics, methenamine, cranberry, topical oestrogens and oral immunostimulants. This paper makes for very good reading. 

Non-antibiotic options for recurrent urinary tract infections in women.
Barclay J, Veeratterapillay R, Harding C.
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Arun K Sharma

West Herts NHS Trust (Watford General Hospital)

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