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

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#urinary-tract-infections #humans #randomized-controlled-trials-as-topic #probiotics #mannose

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

Han et al., 2025 | Infection | Systematic Review

Citation

Han Zeyu, Yi Xianyanling, ... Ai Jianzhong. Nonantibiotic prophylaxis for urinary tract infections: a network meta-analysis of randomized controlled trials. Infection. 2025-Apr;53(2):535-546. doi:10.1007/s15010-024-02357-z

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.

Key Findings

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. Probiotic

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size 10495
Age Range See abstract
Condition See abstract

MeSH Terms

  • Urinary Tract Infections
  • Humans
  • Randomized Controlled Trials as Topic
  • Probiotics
  • Mannose
  • Female
  • Vaccinium macrocarpon
  • Male
  • Adult

Evidence Classification

  • Level: Systematic Review
  • Publication Types: Journal Article, Systematic Review, Network Meta-Analysis
  • Vertical: vitamin-a

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09