Editing Urinary tract infection (section)

==Prevention==
A number of measures have not been confirmed to affect UTI frequency including: urinating immediately after intercourse, the type of underwear used, personal hygiene methods used after urinating or [[defecating]], or whether a person typically bathes or showers.<ref name=Review08/> There is similarly a lack of evidence surrounding the effect of holding one's urine, [[tampon]] use, and [[Douche|douching]].<ref name=NA2011/> In those with frequent urinary tract infections who use [[spermicide]] or a [[diaphragm (contraceptive)|diaphragm]] as a method of contraception, they are advised to use alternative methods.<ref name=Sal2011/> In those with [[benign prostatic hyperplasia]] urinating in a sitting position appears to improve bladder emptying<ref>{{cite journal | vauthors = de Jong Y, Pinckaers JH, ten Brinck RM, Lycklama à Nijeholt AA, Dekkers OM | title = Urinating standing versus sitting: position is of influence in men with prostate enlargement. A systematic review and meta-analysis | journal = PLOS ONE | volume = 9 | issue = 7 | pages = e101320 | date = 2014 | pmid = 25051345 | pmc = 4106761 | doi = 10.1371/journal.pone.0101320 | doi-access = free | bibcode = 2014PLoSO...9j1320D }}</ref> which might decrease urinary tract infections in this group.{{Citation needed|date=January 2022}}

Using urinary catheters as little and as short of time as possible and appropriate care of the catheter when used prevents [[catheter-associated urinary tract infection]]s.<ref name=Nic2001>{{cite journal | vauthors = Nicolle LE | title = The chronic indwelling catheter and urinary infection in long-term-care facility residents | journal = Infection Control and Hospital Epidemiology | volume = 22 | issue = 5 | pages = 316–321 | date = May 2001 | pmid = 11428445 | doi = 10.1086/501908 | s2cid = 40832193 }}</ref> They should be inserted using sterile technique in hospital however non-sterile technique may be appropriate in those who self catheterize.<ref name=Gould2009>{{cite journal | vauthors = Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA | title = Guideline for prevention of catheter-associated urinary tract infections 2009 | journal = Infection Control and Hospital Epidemiology | volume = 31 | issue = 4 | pages = 319–326 | date = April 2010 | pmid = 20156062 | doi = 10.1086/651091 | s2cid = 31266013 | url = https://zenodo.org/record/1235702 | access-date = 2 July 2019 | archive-date = 16 March 2020 | archive-url = https://web.archive.org/web/20200316015723/https://zenodo.org/record/1235702 | url-status = live }}</ref> The urinary catheter set up should also be kept sealed.<ref name=Gould2009/> Evidence does not support a significant decrease in risk when silver-alloy catheters are used.<ref name=Lam2014>{{cite journal | vauthors = Lam TB, Omar MI, Fisher E, Gillies K, MacLennan S | title = Types of indwelling urethral catheters for short-term catheterisation in hospitalised adults | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 9 | pages = CD004013 | date = September 2014 | pmid = 25248140 | doi = 10.1002/14651858.CD004013.pub4 | pmc = 11197149 }}</ref>

===Medications===
[[File:Co-trimoxazole.JPG|thumb|Trimethoprim-Sulfamethoxazole tablets, a commonly used antibiotic for UTI.]]
For those with recurrent infections, taking a short course of antibiotics when each infection occurs is associated with the lowest antibiotic use.<ref name=P2013/> A prolonged course of daily antibiotics is also effective.<ref name=Review08/> Medications frequently used include [[nitrofurantoin]] and [[trimethoprim/sulfamethoxazole]].<ref name=Sal2011/> Some recommend against prolonged use due to concerns of [[antibiotic resistance]].<ref name="P2013" /> [[Methenamine]] is another agent used for this purpose as in the bladder where the acidity is low it produces [[formaldehyde]] to which resistance does not develop.<ref>{{cite book| vauthors = Finkel R, Clark MA, Cubeddu LX |title=Pharmacology |year=2009 |publisher= Lippincott Williams & Wilkins |location= Philadelphia |isbn=9780781771559 |pages=397 |url=https://books.google.com/books?id=Q4hG2gRhy7oC&pg=PA397 |edition=4th |url-status=live |archive-url= https://web.archive.org/web/20160609210228/https://books.google.com/books?id=Q4hG2gRhy7oC&pg=PA397&lpg=PA397 |archive-date=9 June 2016}}</ref> A UK study showed that methenamine is as effective daily low-dose antibiotics at preventing UTIs among women who experience recurrent UTIs. As methenamine is an antiseptic, it may avoid the issue of antibiotic resistance.<ref>{{cite journal |date=20 December 2022 |title=Methenamine is as good as antibiotics at preventing urinary tract infections |url=https://evidence.nihr.ac.uk/alert/methenamine-as-good-as-antibiotics-preventing-urinary-tract-infections/ |journal=NIHR Evidence |doi=10.3310/nihrevidence_55378 |s2cid=254965605 |access-date=20 January 2023 |archive-date=20 January 2023 |archive-url=https://web.archive.org/web/20230120170002/https://evidence.nihr.ac.uk/alert/methenamine-as-good-as-antibiotics-preventing-urinary-tract-infections/ |url-status=live }}</ref><ref>{{cite journal | vauthors = Harding C, Mossop H, Homer T, Chadwick T, King W, Carnell S, Lecouturier J, Abouhajar A, Vale L, Watson G, Forbes R, Currer S, Pickard R, Eardley I, Pearce I, Thiruchelvam N, Guerrero K, Walton K, Hussain Z, Lazarowicz H, Ali A | title = Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women: multicentre, open label, randomised, non-inferiority trial | journal = BMJ | volume = 376 | pages = e068229 | date = March 2022 | pmid = 35264408 | pmc = 8905684 | doi = 10.1136/bmj-2021-0068229 }}</ref>

In cases where infections are related to intercourse, taking antibiotics afterwards may be useful.<ref name=Sal2011/> In post-menopausal women, [[topical]] vaginal [[estrogen]] has been found to reduce recurrence.<ref name="BeerepootGeerlings2016">{{cite journal | vauthors = Beerepoot M, Geerlings S | title = Non-Antibiotic Prophylaxis for Urinary Tract Infections | journal = Pathogens | volume = 5 | issue = 2 | pages = 36 | date = April 2016 | pmid = 27092529 | pmc = 4931387 | doi = 10.3390/pathogens5020036 | type = Review | doi-access = free }}</ref><ref name=Cochrane2008/> As opposed to topical creams, the use of vaginal estrogen from [[Pessary|pessaries]] has not been as useful as low dose antibiotics.<ref name=Cochrane2008>{{cite journal | vauthors = Perrotta C, Aznar M, Mejia R, Albert X, Ng CW | title = Oestrogens for preventing recurrent urinary tract infection in postmenopausal women | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD005131 | date = April 2008 | pmid = 18425910 | doi = 10.1002/14651858.CD005131.pub2 }}</ref> Antibiotics following short term urinary catheterization decreases the subsequent risk of a bladder infection.<ref>{{cite journal | vauthors = Marschall J, Carpenter CR, Fowler S, Trautner BW | title = Antibiotic prophylaxis for urinary tract infections after removal of urinary catheter: meta-analysis | journal = BMJ | volume = 346 | pages = f3147 | date = June 2013 | pmid = 23757735 | pmc = 3678514 | doi = 10.1136/bmj.f3147 }}</ref> A number of [[UTI vaccine]]s are in development as of 2018.<ref>{{cite journal | vauthors = Magistro G, Stief CG | title = Vaccine Development for Urinary Tract Infections: Where Do We Stand? | journal = European Urology Focus | volume = 5 | issue = 1 | pages = 39–41 | date = January 2019 | pmid = 30093359 | doi = 10.1016/j.euf.2018.07.034 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Huttner A, Gambillara V | title = The development and early clinical testing of the ExPEC4V conjugate vaccine against uropathogenic Escherichia coli | journal = Clinical Microbiology and Infection | volume = 24 | issue = 10 | pages = 1046–1050 | date = October 2018 | pmid = 29803843 | doi = 10.1016/j.cmi.2018.05.009 | doi-access = free }}</ref>

===Children===
The evidence that [[preventive medicine|preventive]] antibiotics decrease urinary tract infections in children is poor.<ref name=Child2010>{{cite journal | vauthors = Dai B, Liu Y, Jia J, Mei C | title = Long-term antibiotics for the prevention of recurrent urinary tract infection in children: a systematic review and meta-analysis | journal = Archives of Disease in Childhood | volume = 95 | issue = 7 | pages = 499–508 | date = July 2010 | pmid = 20457696 | doi = 10.1136/adc.2009.173112 | s2cid = 6714180 }}</ref> However recurrent UTIs are a rare cause of further kidney problems if there are no underlying abnormalities of the kidneys, resulting in less than a third of a percent (0.33%) of [[chronic kidney disease]] in adults.<ref>{{cite journal | vauthors = Salo J, Ikäheimo R, Tapiainen T, Uhari M | title = Childhood urinary tract infections as a cause of chronic kidney disease | journal = Pediatrics | volume = 128 | issue = 5 | pages = 840–847 | date = November 2011 | pmid = 21987701 | doi = 10.1542/peds.2010-3520 | s2cid = 41304559 }}</ref> 

==== Male circumcision ====
[[Circumcision]] of boys has been observed to exhibit a strong protective effect against UTIs, with some research suggesting as much as a 90% reduction in  symptomatic UTI incidence among male infants, if they are circumcised.<ref>{{Cite journal |last1=Shaikh |first1=Nader |last2=Morone |first2=Natalia E. |last3=Bost |first3=James E. |last4=Farrell |first4=Max H. |date=Apr 2008 |title=Prevalence of Urinary Tract Infection in Childhood: A Meta-Analysis |url=https://journals.lww.com/00006454-200804000-00004 |journal=Pediatric Infectious Disease Journal |volume=27 |issue=4 |pages=302–308 |doi=10.1097/INF.0b013e31815e4122 |pmid=18316994 |issn=0891-3668}}</ref><ref name=":2">{{Cite journal |last1=Dave |first1=Sumit |last2=Afshar |first2=Kourosh |last3=Braga |first3=Luis H. |last4=Anderson |first4=Peter |date=Feb 2018 |title=Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (full version) |journal=Canadian Urological Association Journal |volume=12 |issue=2 |pages=E76–E99 |doi=10.5489/cuaj.5033 |issn=1911-6470 |pmc=5937400 |pmid=29381458}}</ref> The protective effect is even stronger in boys born with urogenital abnormalities.<ref name=":2" />

===Dietary supplements===
When used as an [[Adjuvant therapy|adjuvant]] to antibiotics and other standard treatments, [[cranberry]] supplements decrease the number of UTIs in people who get them frequently.<ref name="BeerepootGeerlings2016"/><ref>{{cite journal | vauthors = Wang CH, Fang CC, Chen NC, Liu SS, Yu PH, Wu TY, Chen WT, Lee CC, Chen SC | title = Cranberry-containing products for prevention of urinary tract infections in susceptible populations: a systematic review and meta-analysis of randomized controlled trials | journal = Archives of Internal Medicine | volume = 172 | issue = 13 | pages = 988–996 | date = July 2012 | pmid = 22777630 | doi = 10.1001/archinternmed.2012.3004 }}</ref><ref name=":1">{{Cite journal |last1=Xia |first1=Jia-yue |last2=Yang |first2=Chao |last3=Xu |first3=Deng-feng |last4=Xia |first4=Hui |last5=Yang |first5=Li-gang |last6=Sun |first6=Gui-ju |date=2 September 2021 |title=Consumption of cranberry as adjuvant therapy for urinary tract infections in susceptible populations: A systematic review and meta-analysis with trial sequential analysis |journal=PLOS ONE |volume=16 |issue=9 |pages=e0256992 |doi=10.1371/journal.pone.0256992 |doi-access=free |issn=1932-6203 |pmc=8412316 |pmid=34473789|bibcode=2021PLoSO..1656992X }}</ref> A 2023 review concluded that cranberry products can reduce the risk of UTIs in certain groups (women with reoccurring UTIs, children, and people having had clinical interventions), but not in pregnant women, the elderly or people with [[Urination#Disorders|urination disorders]].<ref>{{cite journal | vauthors = Williams G, Stothart CI, Hahn D, Stephens JH, Craig JC, Hodson EM | title = Cranberries for preventing urinary tract infections | journal = The Cochrane Database of Systematic Reviews | volume = 2023 | issue = 11 | pages = CD001321 | date = November 2023 | pmid = 37947276 | pmc = 10636779 | doi = 10.1002/14651858.CD001321.pub7 }}</ref> Some evidence suggests that cranberry juice is more effective at UTI control than dehydrated tablets or capsules.<ref name=":1" /> Cranberry has not been effective in attempts to replace antibiotics for the treatment of active infections.<ref>{{Cite journal |last1=Kwok |first1=Michael |last2=McGeorge |first2=Stephen |last3=Mayer Coverdale |first3=Johanna |last4=Graves |first4=Bianca |last5=Paterson |first5=David L. |last6=Harris |first6=Patrick N.A. |last7=Esler |first7=Rachel |last8=Dowling |first8=Caroline |last9=Britton |first9=Sumudu |last10=Roberts |first10=Matthew J. |date=Nov 2022 |title=Guideline of guidelines: management of recurrent urinary tract infections in women |journal=BJU International |volume=130 |issue=Suppl 3 |pages=11–22 |doi=10.1111/bju.15756 |issn=1464-4096 |pmc=9790742 |pmid=35579121}}</ref> Cranberry supplements are also high in sugar content, which may worsen the risks associated with UTIs in patients with [[Diabetes|diabetes mellitus]].<ref>{{Cite journal |last1=Jepson |first1=Ruth G |last2=Williams |first2=Gabrielle |last3=Craig |first3=Jonathan C |date=17 October 2012 |title=Cranberries for preventing urinary tract infections |journal=The Cochrane Database of Systematic Reviews |volume=2012 |issue=10 |pages=CD001321 |doi=10.1002/14651858.CD001321.pub5 |issn=1469-493X |pmc=7027998 |pmid=23076891}}</ref>

[[Mannose|D-mannose]] is often marketed as a [[dietary supplement]] that prevents UTIs; however, there is little evidence supporting its use. A randomised controlled trial compared daily d-mannose with a placebo (fructose) among women with recurrent urinary tract infections over 6 months. D-mannose offered no benefit over placebo in reducing UTIs.<ref>{{Cite journal |last=Hayward |first=Gail |last2=Mort |first2=Sam |last3=Hay |first3=Alastair D. |last4=Moore |first4=Michael |last5=Thomas |first5=Nicholas P. B. |last6=Cook |first6=Johanna |last7=Robinson |first7=Jared |last8=Williams |first8=Nicola |last9=Maeder |first9=Nicola |last10=Edeson |first10=Rebecca |last11=Franssen |first11=Marloes |last12=Grabey |first12=Jenna |last13=Glogowska |first13=Margaret |last14=Yang |first14=Yaling |last15=Allen |first15=Julie |date=1 June 2024 |title=d-Mannose for Prevention of Recurrent Urinary Tract Infection Among Women: A Randomized Clinical Trial |url=https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2817488 |journal=JAMA Internal Medicine |volume=184 |issue=6 |pages=619–628 |doi=10.1001/jamainternmed.2024.0264 |issn=2168-6106|doi-access=free |pmc=11002776 }}</ref><ref>{{Cite journal |date=6 February 2025 |title=D-mannose does not prevent urinary tract infections |url=https://evidence.nihr.ac.uk/alert/d-mannose-does-not-prevent-urinary-tract-infections-utis/ |journal=NIHR Evidence}}</ref> 

As of 2015, [[probiotics]] require further study to determine if they are beneficial for UTI.<ref>{{cite journal | vauthors = Schwenger EM, Tejani AM, Loewen PS | title = Probiotics for preventing urinary tract infections in adults and children | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 12 | pages = CD008772 | date = December 2015 | pmid = 26695595 | pmc = 8720415 | doi = 10.1002/14651858.CD008772.pub2 }}</ref>