Articles
25 September 2025
Vol. 37 (2025)
https://doi.org/10.4081/uij.2025.352

Breaking the cycle of recurrent urinary tract infections in women: a network meta-analysis of superior preventive measures

Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Medication, preventive, recurrent UTI, meta-analysis
48
Views
20
Downloads

Authors

Revina Maharani
Faculty of Medicine, Medical Faculty, Universitas Brawijaya, Malang, Indonesia.
Satria Rafi Ratmandhika
Faculty of Medicine, Medical Faculty, Universitas Brawijaya, Malang, Indonesia.
Yehezkiel Gian Pradipta Pahu
Faculty of Medicine, Medical Faculty, Universitas Brawijaya, Malang, Indonesia.
Jesphine Arbi Wijaya
Faculty of Medicine, Medical Faculty, Universitas Brawijaya, Malang, Indonesia.
Michelle Vanessa Anggarkusuma
Faculty of Medicine, Medical Faculty, Universitas Brawijaya, Malang, Indonesia.
Besut Daryanto
urobes.fk@ub.ac.id
Department of Urology, Faculty of Medicine, Universitas Brawijaya-Saiful Anwar Hospital, Malang, Indonesia.

Recurrent urinary tract infections (rUTI) impose a substantial burden, particularly on vulnerable populations, such as women. The importance of effective prevention strategies is crucial in reducing the incidence of rUTI. While various preventive measures are available, there remains a gap in knowledge regarding their effectiveness and safety in clinical practice. This study aims to evaluate various interventions’ performance in reducing the risk of rUTI and safety compared to placebo in healthy women. This network meta-analysis (NMA) was conducted according to the Systematic Reviews and Meta-Analyses Preferred Reporting Items for Systematic Reviews and Meta-Analyses NMA Checklist. A systematic search was performed in Scopus, PubMed, CENTRAL, EBSCO, Hindawi, and ProQuest up to June 14th, 2024. Studies that met our eligibility criteria are qualitatively assessed using the Cochrane Risk of Bias Tool 2. Data analysis was conducted using Rstudio v.4.3.1 with the DerSimonian-Laird random-effects model. The p-value was calculated to rank treatments. There were 6325 samples obtained from 40 journals. Fosfomycin-trometamol is the best intervention in preventing rUTI in women [p=0.9965; relative risk (RR)=0.09; 95% confidence interval (CI) 0.05-0.17]. Cranberry extract (p=0.62; RR=0.38; 95% CI 0.24-0.60) and nitrofurantoin (p=0.617; RR=0.38; 95% CI 0.27-0.53) have the most evidence with acceptable RR. Combinations of lactobacillus, cranberry, and D-mannose resulted in the lowest count of adverse effects (p=0.7623; RR=0.9; 95% CI 0.06-13.82). Cranberry extract and nitrofurantoin are highly effective in preventing rUTIs in women. Despite the promising performance of fosfomycin-trometamol, further research is needed to confirm its effectiveness. The composition of lactobacillus, cranberry, and D-mannose appears as the safest option to prevent rUTI.

Altmetrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Yang X, Chen H, Zheng Y, et al. Disease burden and long-term trends of urinary tract infections: a worldwide report. Front Public Health 2022;10:888205. DOI: https://doi.org/10.3389/fpubh.2022.888205
Pardeshi P. Prevalence of urinary tract infections and current scenario of antibiotic susceptibility pattern of bacteria causing UTI. Indian J Microbiol Res 2018;5:334-8. DOI: https://doi.org/10.18231/2394-5478.2018.0070
Al Lawati H, Blair BM, Larnard J. Urinary tract infections: core curriculum 2024. Am J Kidney Dis 2024;83:90-100. DOI: https://doi.org/10.1053/j.ajkd.2023.08.009
Glover M, Moreira CG, Sperandio V, Zimmern P. Recurrent urinary tract infections in healthy and nonpregnant women. Urol Sci 2014;25:1-8. DOI: https://doi.org/10.1016/j.urols.2013.11.007
Lenger SM, Bradley MS, Thomas DA, et al. D-mannose vs other agents for recurrent urinary tract infection prevention in adult women: a systematic review and meta-analysis. Am J Obstet Gynecol 2020;223:265-e1-13. DOI: https://doi.org/10.1016/j.ajog.2020.05.048
Rădulescu D, David C, Turcu FL, et al. Combination of cranberry extract and D-mannose-possible enhancer of uropathogen sensitivity to antibiotics in acute therapy of urinary tract infections: results of a pilot study. Exp Ther Med 2020;20:3399-406. DOI: https://doi.org/10.3892/etm.2020.8970
Murina F, Vicariotto F, Lubrano C. Efficacy of an orally administered combination of Lactobacillus paracasei LC11, cranberry and D-mannose for the prevention of uncomplicated, recurrent urinary tract infections in women. Urologia 2021;88:64-8. DOI: https://doi.org/10.1177/0391560320957483
Aune A, Alraek T, Lihua H, Baerheim A. Acupuncture in the prophylaxis of recurrent lower urinary tract infection in adult women. Scand J Prim Health Care 1998;16:37-9. DOI: https://doi.org/10.1080/028134398750003386
Hutton B, Salanti G, Caldwell DM, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med 2015;162:777-84. DOI: https://doi.org/10.7326/M14-2385
Chandler J, Cumpston M, Li T, et al. Cochrane handbook for systematic reviews of interventions. NJ, USA: Wiley; 2019.
Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019;366:I4898. DOI: https://doi.org/10.1136/bmj.l4898
McGuinness LA, Higgins JPT. Risk‐of‐bias VISualization (robvis): an R package and Shiny web app for visualizing risk‐of‐bias assessments. Res Synth Methods 2021;12:55-61. DOI: https://doi.org/10.1002/jrsm.1411
Susanto H, Arviansyah, Stanza M, et al. (2024) Panduan Penggunaan Antimikroba Profilaksis dan Terapi Edisi IX. 2024. Available from: https://rsusaifulanwar.jatimprov.go.id/file%20download/PPAM%20EDISI%20IX%20TH.2024%20FINAL.pdf.
Schito GC. Why fosfomycin trometamol as first line therapy for uncomplicated UTI? Int J Antimicrob Agents 2003;22:79-83. DOI: https://doi.org/10.1016/S0924-8579(03)00231-0
Rudenko N, Dorofeyev A. Prevention of recurrent lower urinary tract infections by long-term administration of fosfomycin trometamol. Arzneimittelforschung 2005;55:420-7. DOI: https://doi.org/10.1055/s-0031-1296881
Chi-Wai T, Cheon C. Single-dose fosfomycin tromethamine for treatment of urinary tract infection in Hong Kong women: a preliminary prospective study. Hong Kong J Gynaecol Obstet Midwifery 2012;12:121.
Obi E, Darland K, Hudson J, et al. Does cranberry extract taken daily by mouth prevent rUTIs in adult women. Evidence-Based Practice 2021;24:51. DOI: https://doi.org/10.1097/EBP.0000000000001311
Takahashi S, Hamasuna R, Yasuda M, et al. A randomized clinical trial to evaluate the preventive effect of cranberry juice (UR65) for patients with recurrent urinary tract infection. J Infect Chemother 2013;19:112-7. DOI: https://doi.org/10.1007/s10156-012-0467-7
Beerepoot MAJ, ter Riet G, Nys S, et al. Cranberries vs antibiotics to prevent urinary tract infections: a randomized double-blind noninferiority trial in premenopausal women. Arch Intern Med 2011;171:1270-8. DOI: https://doi.org/10.1001/archinternmed.2011.306
Uehling DT, Hopkins WJ, Beierle LM, et al. Vaginal mucosal immunization for recurrent urinary tract infection: extended phase II clinical trial. J Infect Dis 2001;183:S81-3. DOI: https://doi.org/10.1086/318839
Uehling DT, Hopkins WJ, Elkahwaji JE, et al. Phase 2 clinical trial of a vaginal mucosal vaccine for urinary tract infections. J Urol 2003;170:867-9. DOI: https://doi.org/10.1097/01.ju.0000075094.54767.6e
Hopkins WJ, Elkahwaji J, Beierle LM, et al. Vaginal mucosal vaccine for recurrent urinary tract infections in women: results of a phase 2 clinical trial. J Urol 2007;177:1349-53. DOI: https://doi.org/10.1016/j.juro.2006.11.093
Weihrauch TR, Gauler TR. Placebo-efficacy and adverse effects in controlled clinical trials. Arzneimittelforschung 1999;49:385-93. DOI: https://doi.org/10.1055/s-0031-1300432

How to Cite



Breaking the cycle of recurrent urinary tract infections in women: a network meta-analysis of superior preventive measures. (2025). Urogynaecologia, 37. https://doi.org/10.4081/uij.2025.352
Copyright (c) 2025 the Author(s) Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.