Nonantibiotic prophylaxis for urinary tract infections: a network meta-analysis of randomized controlled trials

• Published in: Infection Vol. 53; no. 2; pp. 535 - 546
• Main Authors: Han, Zeyu, Yi, Xianyanling, Li, Jin, Liao, Dazhou, Ai, Jianzhong
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.04.2025; Springer Nature B.V
• Subjects: Adult; Antibiotics; Clinical trials; Cranberries; disease prevention; Effectiveness; Family Medicine; Female; General Practice; Humans; infection; Infectious Diseases; Internal Medicine; Male; Mannose; Mannose - therapeutic use; Medicine; Medicine & Public Health; meta-analysis; Placebos; Prevention; Probiotics; Probiotics - therapeutic use; Prophylaxis; Randomized Controlled Trials as Topic; relative risk; Subgroups; therapeutics; Urinary tract; Urinary tract diseases; Urinary tract infections; Urinary Tract Infections - prevention & control; Urogenital system; Vaccines; Vaccinium macrocarpon; Vitamin A; Vitamin D; Prevention; Urinary tract infection; Network meta-analysis; Nonantibiotic; Randomized controlled trial
• ISSN: 0300-8126; 1439-0973; 1439-0973
• DOI: 10.1007/s15010-024-02357-z

Objective Recent guidelines indicated that, in addition to antibiotics, nonantibiotic interventions serve as available preventive options for urinary tract infections (UTIs). This study aimed to compare the efficacy and safety of various nonantibiotic interventions in preventing UTIs. Methods The authors systematically searched databases for eligible studies. The inclusion criteria encompassed randomized controlled trials (RCTs) focusing on one or more nonantibiotic interventions for UTI prevention, with the incidence of UTIs being a key outcome measure. Subgroup analyses were performed according to age, sex, and follow-up. Results 50 RCTs comprising 10,495 subjects and investigating 14 interventions, were included. Nearly 80% of the RCTs utilized double-blind or triple-blind designs. In the whole group, D-mannose (risk ratio [RR] 0.34, 0.21 to 0.56), vaccine (RR 0.65, 0.52 to 0.82), probiotics (RR 0.69, 0.50 to 0.94), cranberry (RR 0.72, 0.60 to 0.87), and triple therapy (cranberry plus probiotics plus vitamin A) (RR 0.27, 0.09 to 0.87), exhibited a significant reduction in UTI incidence compared to the placebo. Probiotics (RR 0.50, 0.28 to 0.89) were the most effective in the nonadult group, while vitamin D (RR 0.46, 0.27 to 0.81) showed the highest efficacy in the long follow-up group (≥ 1 year). There was no significant difference in the incidence of adverse events between the interventions and the placebo group. Conclusions D-mannose, triple therapy, vaccine, probiotics, and cranberry serve as potential nonantibiotic intervention options for clinical UTI prevention.