#233 Drink Up: Increasing Fluid Intake to Prevent Recurrent UTIs
CLINICAL QUESTION
Does increasing water intake prevent recurrent urinary tract infections (UTIs)?
BOTTOM LINE
Based on 1 RCT in women with recurrent UTIs (average 3.3 per year) and low fluid intake (less than 1.5L/day), increasing water intake by an additional ~1.5 L/day results in 1.5 fewer UTIs and 1.7 fewer antibiotic prescriptions per patient after 1 year compared to those who don't change intake. Over 90% of women with increased water intake will have fewer than 3 episodes of UTIs per year.
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EVIDENCE
Only 1 Randomized Controlled Trial (RCT),
- 1 open-label RCT in 140 non-pregnant, premenopausal women (mean age 36) with at least 3 UTIs (mean 3.3) in last year and self-reported low fluid intake (less than 1.5 L/day). Randomized to increasing water intake by 1.5L/day or no change in intake. After one year (statistically significant unless indicated):1
- Mean number of UTIs: 1.7 versus 3.2 control.
- Number of women with fewer than 3 UTIs per year: 93% versus 12% control (number needed to treat=2).
- Mean number of antibiotic regimens for cystitis: 1.9 versus 3.6 control.
- Adverse effects: no difference.
- Mean voids per day: 8.2 versus 5.9 control.
CONTEXT
- To increase fluid intake, participants were instructed to start drinking new 500ml bottle of water at the beginning of a meal and finish it before the next meal.1
- Similar approach to increasing water intake successful in other RCTs (not examining UTI prevention).2
- "Bottles" were NOT required in other studies.2
- Similar approach to increasing water intake successful in other RCTs (not examining UTI prevention).2
- Low daily water intake associated with increased risk of UTIs.3
- Other considerations for recurrent UTIs:
- Cranberry juice: inconsistent evidence and potential weight gain (5.8kg in 6 months) with routine use.4
- Probiotics: no benefit. 5
- Vaginal estrogen (postmenopausal women): minimal evidence,6 example versus placebo: NNT=3 for prevention.7
- Adverse effects: not statistically different.
- Oral estrogens: no benefit.6
- Antibiotic prophylaxis versus placebo:8 NNT=3 for prevention.
- Adverse effects: Number needed to harm=13.
- Stopping for adverse effects: no difference.
- Adverse effects: Number needed to harm=13.
- Most patients with recurrent UTIs do not have anatomical abnormalities.9
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