Tools for Practice Outils pour la pratique


#233 Drink Up: Increasing Fluid Intake to Prevent Recurrent UTIs


CLINICAL QUESTION
QUESTION CLINIQUE
Does increasing water intake prevent recurrent urinary tract infections (UTIs)?


BOTTOM LINE
RÉSULTAT FINAL
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
DONNÉES PROBANTES
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. 
Study managed by a bottled water company and water provided at no cost.  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 
  • 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,6example 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. 
  • Most patients with recurrent UTIs do not have anatomical abnormalities.9 


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Author(s)
Auteur(s)
  • Adrienne J Lindblad BSP ACPR PharmD
  • Rodger Craig MPH

1. Hooton TM, Vecchio M, Iroz A, et al. JAMA Intern Med. 2018;178(11):1509-15.

2. Chua TXW, Prasad NH, Rangan GK, et al. Nephrology. 2016; 21:860-9.

3. Yoon BI, Kim SW, Ha US, et al. J Infect Chemother. 2013; 19:727-31.

4. Allan GM, Nicolle L. Cranberry juice/tablets for the prevention of urinary tract infection: naturally the best? Tools for Practice online publication. Published August 10, 2016. Available at: https://gomainpro.ca/wp-content/uploads/tools-for-practice/1482257759_2016updatedtfp84cranberryforutiprevention.pdf Accessed February 7, 2019.

5. Schwenger EM, Tejani AM, Loewen PS. Cochrane Database System Rev. 2015;2:CD008772.

6. Perrotta C, Aznar M, Meija R, et al. Cochrane Database System Rev. 2008;2:CD005131.

7. Raz P, Stamm WE. New Engl J Med. 1993; 329(11):753-6.

8. Albert X, Huertas I, Pereiro I, et al. Cochrane Database System Rev. 2004;3: CD001209.

9. Dason S, Dason JT, Kapoor A. Can Urol Assoc J. 2011; 5(5):316-22.

Authors do not have any conflicts of interest to declare.

Les auteurs n’ont aucun conflit d’intérêts à déclarer.