Recurrent Urinary Tract Infection Care

Integrating Complementary and Alternative Medicine

Feng Feng; Jane Hokanson Hawks; Jeanine Kernen; Eric Kyle


Urol Nurs. 2018;38(5):231-235. 

In This Article

Natural Therapies

It is well established that appropriate continuous antibiotic therapy provides effective management of rUTI. However, the optimal prophylactic antibiotic is unknown. Allergies, prior susceptibility, local resistance patterns, cost, and side effects should be considered when choosing an antibiotic for long-term use (Beerepoot & Geerlings, 2016; Kranz et al., 2017). Once prophylactic antibiotics are discontinued, 50% to 60% of women will develop a recurrent infection within three months (Flower et al., 2016).


Cranberry is widely accepted as a substance that may reduce the risk of UTIs and rUTIs. Many women use some type of cranberry therapy, often for several years. However, data are still conflicting. Cranberry contains Type A pro-antho-cyanidins, which can prevent adherence of bacteria to the bladder epithelium (Bergamin & Kiosoglous, 2017).

Research data support the use of cranberry therapy for prevention of UTI or rUTI. Durham, Stamm, and Eiland (2015) reviewed eight clinical trials and concluded that cranberry products (mostly juice) appeared to be effective for UTI prevention in healthy children and at least as effective as antibiotics in children with underlying urogenital abnormalities. However, recommendations for cranberry dosing and frequency cannot be confidently made until larger well-designed clinical trials are completed (Durham et al., 2015). Foxman, Cronenwett, Spino, Berger, and Morgan (2015) conducted a randomized, double-blind, placebo-controlled trial of the therapeutic efficacy of cranberry capsules in preventing UTI in 160 women undergoing elective gynecological surgery with catheters postoperatively. Use of the cranberry extract capsules during the postoperative period reduced the rate of UTI by half of the women in the experimental group.

Fernández-Puentes and colleagues (2015) performed a controlled, double-blind, trial on children older than 1 month of age to evaluate the efficacy and safety of cranberry in rUTI in 192 patients, with 75 patients receiving trimethoprim and 115 patients receiving cranberry prophylaxis. They concluded that cranberry is safe and effective in the prophylaxis of rUTI in infants and children. However, a database review noted no significant improvement in UTI treatment while using cranberry juice compared to the control group (Jepson, Williams, & Craig, 2012). This review by the authors was the third update of their review first published in 1998 and updated in 2004 and 2008. The updated review included a total of 24 studies with a total of 4,473 participants. Prior to the current update, it seemed cranberry juice may decrease the number of UTIs over a 12-month period in women with rUTIs. However, with the addition of 14 studies, the authors concluded that cranberry juice may be less effective than previously indicated.


D-mannose is a natural sugar that seems to hinder bacteria adhesion to the uroepithelial cells that line the urinary tract. Several research studies indicate D-mannose is effective in eliminating E.coli, thereby preventing rUTI (DeLeo, Cappelli, Massaro, Tosti, & Morgante, 2017; Genovese et al., 2017). Beerepoot and Geerlings (2016) report there is a significant decrease of rUTIs when patients use D-mannose compared to those who do not or those who use other prophylaxis. In addition, cranberry contains D-mannose, which may explain why it may aid in UTI prevention (Kranj?ec, Papeš, & Altarac, 2013).

Other Natural Products

Vitamin C has been used by many women, but results are not promising (Beerepoot & Geerlings, 2016, Bergamin & Kiosoglous, 2017). Vitamin C can lower urine pH and play a role in bacteriostasis, but there were no convincing data reviewed in this search to suggest vitamin C use decreases the risk of rUTI.

Pang and Ali (2015) reported that nutraceuticals, L-arginine, and quercetin have also been used to relieve signs and symptoms of rUTI, and are thought to be effective because of their anti-inflammatory, antioxidant, and immuno-regulatory properties (Pang & Ali, 2015).

Chinese herbs, such as Ba Zheng powder, are a viable alternative option for rUTI treatment (Flower et al., 2016; Liu et al., 2017). Uva Ursi (bearberry) is widely accepted in Europe for the prevention of rUTIs because it has diuretic, urinary antiseptic, astringent, and anti-inflammatory properties (Trill et al., 2017). Other supplements not discussed in this article are also helpful, including probiotics and antioxidants. Additional research on these regimens is needed in the future.

Hydration and Diet Changes

Diet changes and hydration can be used to prevent rUTI, promoting recovery and detoxification. Dietary changes, such as limiting tomato products, soy products, a variety of spices, and other bladder irritants, may result in an improvement of signs and symptoms associated with rUTI (Oh-Oka, 2017). Increasing fluid intake helps rid the bladder of micro-organisms during acute episodes of UTI, and maintaining increased hydration and increasing urinary output can prevent retrograde migration of microbes into the bladder and move them out more quickly before they can get established (Bergamin & Kiosoglous, 2017).