ㅤTake-home message from Walter E. Stamm 1982, published in The New England Journal of Medicine):
Conversely to the traditional diagnostic criterion (≥105 bacteria per millimeter of midstream urine), in female patients presenting with symptoms of UTI:
The best diagnostic criterion is ≥10^2 bacteria per millimeter (sensitivity, 0.95; specificity, 0.85).
The presence of pyuria plus ≥10^2 coliforms per millimeter improved the specificity slightly, but decreased the sensitivity (0.86).
ㅤTake-home message from Wagenlehner 2014, published in Antimicrobial Agents and Chemotherapy):
This trial investigated the urinary concentrations of Nitroxoline 250 Milligrams versus Trimethoprim 200 Milligrams and their antibacterial activities (urinary inhibitory titers [UITs] and urinary bactericidal titers [UBTs]) against uropathogens at three different urinary pH values within 24 h in six healthy volunteers after a single oral dose.
Nitroxoline is a more active antibacterial in acidic urine, while trimethoprim is more active in alkaline urine.
The urinary inhibitory titers and urinary bactericidal titers of nitroxoline were generally lower than those of trimethoprim.
Nitroxoline exhibited mainly bacteriostatic activity in urine. TMP showed both bacteriostatic and bactericidal activity.
ㅤTake-home message from Lenger S. M. 2020, published in American Journal of Obstetrics & Gynecology):
D-mannose shows:
Higher protection from recurrent UTIs compared to placebo
Similar effectiveness as antibiotics, with less side effects
Good tolerability and compliance, although limited data
ㅤTake-home message from Néha Sihra 2018, published in Nature Reviews Urology):
Alternatives to antibiotics for the prevention of recurrent urinary tract infection are attractive options to reduce the risks of antimicrobial resistance.
The most commonly studied nonantibiotic management options for recurrent urinary tract infections are cranberries, probiotics, d-mannose, methenamine hippurate, estrogens, intravesical glycosaminoglycans and immunostimulants.
Studies of novel vaccines targeting the adherence mechanisms of uropathogenic bacteria seem promising, but human trials are required to determine the efficacy of this approach.
Evidence for the nonantibiotic measures is hampered by considerable heterogeneity, and further high-quality trials are needed.
ㅤTake-home message from Beerepoot 2013, published in The Journal of Urology):
To prevent recurrent urinary tract infection (rUTI) with nonantibiotic methods:
Oral immunostimulant OM-89 is useful and decrease rUTI by ~40%
Vaginal estrogen can prevent rUTI in postmenopausal women (decrease by ~60%)
Vaginal vaccine Urovac, cranberry products and acupuncture appear to reduce rUTI, but further studies are required
Lactobacilli and oral oestrogens do not reduce rUTI based on current evidence
ㅤTake-home message from Harding 2021, published in British Medical Journal):
Methenamine Hippurate is a non-antibiotic medication that is as good as daily antibiotic prophylaxis for preventing recurrent UTIs in women.
ㅤTake-home message from Gai Milo 2005, published in Cochrane Database of Systematic Reviews):
3-days antibiotic therapy was adequate in providing symptomatic relief for most women with uncomplicated urinary tract infections
Longer therapeutic duration is linked to increased risk of adverse events
Longer therapeutic duration offers benefit in eliminating bacteria from patient's urine and hence should still be considered for women where recurrence prevention is the priority
ㅤTake-home message from Ruth G Jepson 2012, published in Cochrane Databse of Systematic Reviews):
Cranberry products do not lead to a statistically significant decrease in UTI incidence. They are neither better nor worse than antibiotics for preventing UTI. As such, cranberry products are not recommended for the prevention of UTI.
ㅤTake-home message from Cristóbal Ramírez Sevilla 2019, published in BMC Infectious Diseases:
Uromune, a bacterial vaccine, is an effective alternative to antibiotics for the prevention of uncomplicated recurrent urinary tract infections.
Sublingual spray of Uromune (administered daily for 03-months) reduced the number of UTI episodes to ≤1 in 71.7% and ≤1 in 64.7%.of patients, when checked at three months and six months respectively after stopping the drug.
ㅤTake-home message from Bojana Kranjcec 2013, published in World Journal of Urology):
In women with recurrent urinary tract infection, D-mannose taken for 6 months is equally effective as administration of low dose antibiotics (prophylactic Nitrofurantoin).