Nonantibiotic Prophylaxis for Recurrent Urinary Tract Infections: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

No AccessJournal of UrologyReview Article1 Dec 2013Nonantibiotic Prophylaxis for Recurrent Urinary Tract Infections: A Systematic Review and Meta-Analysis of Randomized Controlled Trials M.A.J. Beerepoot, S.E. Geerlings, E.P. van Haarst, N. Mensing van Charante, and G. ter Riet M.A.J. BeerepootM.A.J. Beerepoot Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Amsterdam, The Netherlands , S.E. GeerlingsS.E. Geerlings Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Amsterdam, The Netherlands , E.P. van HaarstE.P. van Haarst Department of Urology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands , N. Mensing van CharanteN. Mensing van Charante Department of Gynecology, Academic Medical Center, Amsterdam, The Netherlands , and G. ter RietG. ter Riet Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands View All Author Informationhttps://doi.org/10.1016/j.juro.2013.04.142AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Increasing antimicrobial resistance has stimulated interest in nonantibiotic prophylaxis of recurrent urinary tract infections. We assessed the effectiveness, tolerability and safety of nonantibiotic prophylaxis in adults with recurrent urinary tract infections. Materials and Methods: MEDLINE®, EMBASE™, the Cochrane Library and reference lists of relevant reviews were searched to April 2013 for relevant English language citations. Two reviewers selected randomized controlled trials that met the predefined criteria for population, interventions and outcomes. The difference in the proportions of patients with at least 1 urinary tract infection was calculated for individual studies, and pooled risk ratios were calculated using random and fixed effects models. Adverse event rates were also extracted. The Jadad score was used to assess risk of bias (0 to 2—high risk and 3 to 5—low risk). Results: We identified 5,413 records and included 17 studies with data for 2,165 patients. The oral immunostimulant OM-89 decreased the rate of urinary tract infection recurrence (4 trials, sample size 891, median Jadad score 3, RR 0.61, 95% CI 0.48–0.78) and had a good safety profile. The vaginal vaccine Urovac® slightly reduced urinary tract infection recurrence (3 trials, sample size 220, Jadad score 3, RR 0.81, 95% CI 0.68–0.96) and primary immunization followed by booster immunization increased the time to reinfection. Vaginal estrogens showed a trend toward preventing urinary tract infection recurrence (2 trials, sample size 201, Jadad score 2.5, RR 0.42, 95% CI 0.16–1.10) but vaginal irritation occurred in 6% to 20% of women. Cranberries decreased urinary tract infection recurrence (2 trials, sample size 250, Jadad score 4, RR 0.53, 95% CI 0.33–0.83) as did acupuncture (2 open label trials, sample size 165, Jadad score 2, RR 0.48, 95% CI 0.29–0.79). Oral estrogens and lactobacilli prophylaxis did not decrease the rate of urinary tract infection recurrence. Conclusions: The evidence of the effectiveness of the oral immunostimulant OM-89 is promising. Although sometimes statistically significant, pooled findings for the other interventions should be considered tentative until corroborated by more research. Large head-to-head trials should be performed to optimally inform clinical decision making. 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A Systematic Review with Meta-Analysis and Trial Sequential Analysis of Clinical TrialsJournal of Urology, VOL. 198, NO. 3, (614-621), Online publication date: 1-Sep-2017.Krieger J (2013) Prophylaxis in Urology is No Longer Easy—Should We Use More or Fewer Antibiotics?Journal of Urology, VOL. 190, NO. 6, (1972-1973), Online publication date: 1-Dec-2013. Volume 190 Issue 6 December 2013 Page: 1981-1989 Supplementary Materials Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Keywordsurinary tract infectionsprevention and controlreviewmeta-analysisMetrics Author Information M.A.J. Beerepoot Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Amsterdam, The Netherlands More articles by this author S.E. Geerlings Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Amsterdam, The Netherlands More articles by this author E.P. van Haarst Department of Urology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands More articles by this author N. Mensing van Charante Department of Gynecology, Academic Medical Center, Amsterdam, The Netherlands More articles by this author G. ter Riet Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands More articles by this author Expand All Advertisement PDF downloadLoading ...