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

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Abstract

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.

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Data availability

No datasets were generated or analysed during the current study.

Abbreviations

UTIs:

urinary tract infections

AUA/CUA/SUFU:

American Urological Association /Canadian Urological Association/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction

NMA:

network meta-analysis

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

RCTs:

randomized controlled trials

AEs:

adverse events

CINeMA:

Confidence in Network Meta-Analysis

RR:

risk ratio

CIs:

confidence intervals

SEIMC:

Spanish Society of Infectious Diseases and Clinical Microbiology

SSGO:

The Swiss Society of Gynecology and Obstetrics

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Acknowledgements

None.

Funding

This study was supported by the National Key R&D Program of China (2023YFC3403200), the National Natural Science Foundation of China (82070784 and 81702536), and the Science & Technology Department of Sichuan Province, China (2022JDRC0040).

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Authors and Affiliations

  1. Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 88 South Keyuan Road, Chengdu, 610041, China

    Zeyu Han, Xianyanling Yi, Jin Li, Dazhou Liao & Jianzhong Ai

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Contributions

JA and ZH conceived the project and drafted the manuscript. ZH, XY, and JL performed the study design and data extraction. JL and DL performed the statistical analysis. JA revised the manuscript. All authors have read and approved the final manuscript.

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Correspondence to Jianzhong Ai.

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The authors declare no competing interests.

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Han, Z., Yi, X., Li, J. et al. Nonantibiotic prophylaxis for urinary tract infections: a network meta-analysis of randomized controlled trials. Infection (2024). https://doi.org/10.1007/s15010-024-02357-z

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