EXECUTIVE SUMMARY

Research presented at the 2017 annual meeting of the Infectious Diseases Society of America indicates that women at risk of urinary tract infection (UTI) who increased their water intake by drinking an additional three pints of water a day were almost half as likely to get infections as women who did not.

  • It is estimated that at least 40-60% of women develop a UTI during their lifetime, with one in in four women likely to experience a repeat infection.
  • A three-day antimicrobial regimen is now the recommended treatment for uncomplicated acute bacterial cystitis. Trimethoprim-sulfamethoxazole for three days is considered the preferred therapy.

It is estimated that at least 40-60% of women develop a urinary tract infection (UTI) during their lifetime, with one in in four women likely to experience a repeat infection.1 Women’s health clinicians are all too familiar with UTIs. In one year, of the estimated 11 million office and outpatient hospital UTI visits by patients 20 years of age and older, about 9 million visits were logged by women.2

Research presented at the 2017 annual meeting of the Infectious Diseases Society of America indicates that women at risk of UTIs who increased their water intake by drinking an additional three pints of water a day were almost half as likely to get infections as women who did not.3 General daily recommendations for intake of total water — from all beverages and foods — is 2.7 liters (91 ounces) for women and about 3.7 liters (125 ounces) for men.4

“While doctors have long assumed this is the case and often recommended that women at risk for UTIs increase their fluid intake, it’s never really undergone a prospective trial before,” notes Thomas Hooton, MD, lead author of the study and clinical director of the division of infectious diseases at the University of Miami School of Medicine. “It’s good to know the recommendation is valid, and that drinking water is an easy and safe way to prevent an uncomfortable and annoying infection.”

To conduct the study, researchers followed 140 healthy premenopausal women who had at least three UTIs in the past year and reported low daily fluid intake. Women in the control group continued their usual daily fluid intake; those not in the control group were advised to drink 1.5 liters (about three 16-ounce glasses) of water a day in addition to their usual daily fluid intake. Data indicate that after one year, women in the control group had 3.1 UTIs on average, while those in the group drinking additional water had 1.6 UTIs on average. Women in the water group averaged fewer regimens of antibiotics (1.8) than the limited-water group (3.5).3

Antibiotic Resistance Is a Concern

Urinary tract infections are bacterial in nature and may involve the lower or upper urinary tract or both. Cystitis is diagnosed when infection is limited to the lower urinary tract and presents with dysuria, frequent and urgent urination, and suprapubic tenderness in some instances. Acute pyelonephritis is diagnosed when there is infection of the renal parenchyma and pelvicaliceal system, accompanied by significant bacteriuria with fever and flank pain.5

A three-day antimicrobial regimen is now the recommended treatment for uncomplicated acute bacterial cystitis.5 Trimethoprim-sulfamethoxazole for three days is considered the preferred therapy, offering a 94% bacterial eradication rate. In areas where antimicrobial resistance to trimethoprim-sulfamethoxazole exceeds 15-20%, clinicians may look at using trimethoprim alone, ciprofloxacin, levofloxacin, norfloxacin, or gatifloxacin.5

Antimicrobial resistance is a valid concern for healthcare providers. Data from areas reporting antimicrobial susceptibility profiles reflect the prevalence of resistance to amoxicillin and trimethoprim-sulfamethoxazole as high as 30% in some populations.5

Consider Cranberry Products

Results of a recent meta-analysis and assessment of human clinical trials suggest that cranberry products may be used as a first step in reducing recurrent UTIs.6 Such products are a low-cost, low-risk, and effective way to help prevent recurrent UTIs, researchers state. The analysis included 28 studies, with results from nearly 5,000 patients. Researchers found a statistically significant risk reduction in repeat UTIs overall, but not significant for any particular subgroup. Patients with recurrent UTIs who ingested cranberry products and had undergone gynecological surgery experienced a significant reduction in UTIs, the analysis suggests.6

The proanthocyanidins in cranberry fruit are bioactive components assoc-iated with prevention of urinary tract infections.7 Their ability to inhibit bacteria from sticking to the urinary tract walls may lead to their effectiveness in limiting infection growth and recurrence, scientists believe.

“Our investigation supports that cranberry products can be a powerful tool to fight off frequent UTIs,” says lead author, Ângelo Luís, PhD, a researcher at the University of Beira Interior in Covilhã, Portugal. “While recommendations for dosage and duration of treatment require further study, the efficacy of the medicinal properties of cranberry products has been well-established.” 

REFERENCES

  1. Franco AV. Recurrent urinary tract infections. Best Pract Res Clin Obstet Gynaecol 2005;19:861-873.
  2. Griebling TL. Urologic diseases in America project: Trends in resource use for urinary tract infections in women. J Urol 2005;173:1281-1287.
  3. Hooton TM, Vecchio M, Iroz A, et al. Prevention of recurrent acute uncomplicated cystitis by increasing daily water in premenopausal women: A prospective randomized controlled study. Presented at: IDWeek 2017. San Diego; October 2017.
  4. Institute of Medicine. Dietary Reference Intakes: Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC; 2014.
  5. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 91: Treatment of urinary tract infections in nonpregnant women. Obstet Gynecol 2008 (reaffirmed 2016);111:785-794.
  6. Luis A, Domingues F, Pereira L. Can cranberries contribute to reduce the incidence of urinary tract infections? A systematic review with meta-analysis and trial sequential analysis of clinical trials. J Urol 2017;198:614-621.
  7. Krueger CG, Reed JD, Feliciano RP, Howell AB. Quantifying and characterizing proanthocyanidins in cranberries in relation to urinary tract health. Anal Bioanal Chem 2013;405:4385-4395.