Recurrent UTIs: which non-antibiotic approaches actually work?

Today, we’re speaking to Professor Miriam Santer, a GP in Dorset and Professor of Primary Care Research based at the University of Southampton.Title of paper: Non-antibiotic interventions to prevent recurrent urinary tract infections in women: overview of systematic reviews of randomised controlled trialsDOI: https://doi.org/10.3399/BJGP.2026.0055Recurrent urinary tract infection (UTI) is very common and defined as two or more UTIs in the last six months or three or more UTIs in the last 12 months. Long-term antibiotic prophylaxis is widely used but other preventative strategies have been suggested. This overview of systematic reviews found good evidence for some treatments but identified unresolved questions such as treatment adherence for vaginal oestrogen, questions about long-term use for methenamine hippurate and optimal dosage for cranberry. Increased fluid intake has been shown to be of benefit for women drinking less than 1.5 litres at baseline but is without robust evidence in other groups. The evidence base is still developing for other treatments, such as vaccines.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:00.560 - 00:00:55.830Hi and welcome today to BJJP interviews.I'm Nada Khan and I'm the Senior Research editor for the bjgp.In today's episode, we're talking to Professor Miriam Santer, a GP in Dorset and Professor of Primary care research based at the University of Southampton.We're here to discuss the recent paper she's published here in the BJJP titled Non Antibiotic Interventions to Prevent Recurrent Urinary Tract Infections in Women.An Overview of Systematic Reviews of Randomized Controlled Trials.So, hi Miriam, it's nice to see you again.And I suppose to start with, it's worth acknowledging that recurrent UTIs are something that we see incredibly often as GPs, but they can also have a really big impact on women's lives and I guess I just wanted to go through what prompted you to take this angle in this review and think about non antibiotic options for preventing them?Speaker B00:00:56.520 - 00:02:38.580Well, it was exactly that, that I had a colleague, a non clinical colleague who had recurrent UTI and I guess I hadn't really appreciated the massive impact that they had in terms of, you know, keeping, being ill, keeping missing work, everything else.And it did make me think again about my own practice, whether I really manage recurrent UTI or whether I just manage it as a series of one off events.So it made me think about my own practice.And then also the reason we looked at non antibiotic options was because the Primary Care Research Centre in Southampton where I work, we do a lot of work on infections and on antimicrobial stewardship and we were aware that prophylactic antibiotics tend to be quite well used and also series of one off antibiotic episodes are quite well used but that the non antibiotic interventions, we felt they were less well used and just wanted to know the evidence behind it.Apart from doing infections research, we also do a lot of research on how to support people self manage long term conditions and we thought we could make a brilliant resource or online intervention to help people prevent urinary tract infection.And as part of that we just wanted to know a bit more about the evidence based and in some ways we were a little disappointed that there wasn't much evidence for some of the very commonly advised things, but also surprised that for some things like methenamine and vaginal estrogen, actually the evidence base is, is pretty well established now.So it was interesting.Speaker A00:02:38.900 - 00:03:04.080Yeah.And as you said, there's a huge number of things that women are told might help prevent recurrent UTIs and this was an umbrella review that brought together evidence from 27 systematic reviews.But let's just talk through what.So you mentioned about vaginal oestrogen, because this seems to be one of the clearest messages from the review.Talk us through what you found and how strong is the evidence here?Speaker B00:03:04.480 - 00:04:07.360So there were seven systematic reviews covering vaginal estrogen and they were pretty positive and especially the most recent one.To be fair, most of the evidence is in post menopausal women, but the NICE guideline changed in 2024 to say perimenopausal and postmenopausal, because there's awareness in the rest of the me