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Treating Recurrent UTIs Without Antibiotics
Urinary tract infections are incredibly widespread, affecting approximately 50% of women and 10% of men at some point in their lives.
These infections arise when bacteria proliferate in the urinary tract, which includes the bladder, urethra and kidneys.
Most UTIs originate in the lower urinary tract, where bacteria enter through the urethra and spread up towards the bladder, which can lead to cystitis, a painful infection.
A prominent symptom associated with classic UTIs is urgency—a strong and uncontrollable need to urinate that can't be delayed.
Other common symptoms include frequent urination, burning sensations, bladder pain, incontinence, changes in urine odor and a general feeling of unwellness.
For many, the battle with a UTI doesn't end with a single infection.
Patients who struggle with recurrent urinary tract infections are often recommended to consult with a urologist like Anne Cameron, M.D., a recognized expert at the University of Michigan.
Cameron holds the James Montie M.D. Legacy Professorship of Urology at U-M Medical School, and currently serves as the vice chair of academic affairs and service chief for the Department of Urology at Michigan Medicine.
To be classified as having recurrent UTIs, an individual must experience multiple infections within a defined timeframe—specifically, three or more in a year, or two within a six-month period.
Recurrent UTIs are not an uncommon issue, affecting around 30% of all women who have had a UTI.
"When patients experience a pattern of recurring infections, it becomes very important to conduct more testing," Cameron emphasized.
Treating a UTI
The American Urological Association and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction recommend a straightforward antibiotic approach for treating typical uncomplicated UTIs in women.
When a patient presents with an acute onset of classic UTI symptoms, but no fever, flank pain, or signs of more serious conditions like a kidney infection, it's reasonable to begin a short course of antibiotics without waiting for culture results.
One antibiotic option is double-strength trimethoprim-sulfamethoxazole, taken twice a day for three days.
Alternatively, Cameron often recommends 100 mg of nitrofurantoin, administered twice daily for five days (though it's important to note that this treatment isn't suitable for individuals with chronic renal failure.)
However, when it comes to treating patients experiencing recurrent UTIs, the approach shifts significantly.
"In these cases, we need to obtain a urine culture before initiating treatment," said Cameron.
"This is crucial because the symptoms of recurrent UTIs can overlap with other bladder conditions, such as interstitial cystitis or bladder pain syndrome and those with recurrent UTIs often have resistant organisms."
When diagnosing a UTI, the process often starts with a dipstick test to check for white cell activity and nitrites.
A positive result strongly suggests a UTI, while a negative result usually rules it out, negating the need for culture testing.
If the dipstick comes back positive, it could also indicate irritation rather than an infection.
Some women experience a rebound in their urinary tract infection even after being prescribed antibiotics, often due to the selection of an ineffective medication.
This can happen when a urine culture isn't performed, which is crucial in identifying the specific bacteria causing the infection and pinpointing which antibiotics will be most effective.
Without this critical step, a woman may receive an antibiotic that either does not eliminate the bacteria or only weakly suppresses it, possibly leading to a return of symptoms.
Certain medical conditions can also complicate antibiotic treatment.
Even when the correct antibiotic is prescribed, various patient-specific factors can affect its absorption and efficacy.
Some women are also inherently at higher risk for UTIs due to anatomical factors or medical history.
Prevention strategies for UTIs
Preventing recurrent UTIs involves a combination of practical strategies that can considerably improve urinary health.
Several risk factors can increase the likelihood of developing UTIs, including not drinking enough liquids, chronic constipation or diarrhea, incomplete bladder emptying, and various bowel issues.
"Typically, I give common sense advice: stay hydrated, urinate after intercourse, don't do too much hygiene: douching, washing the vagina/vulva with soap is counterproductive – UTIs rarely occur because you are dirty or have hygiene issue, it is bad luck or inherent risk factors," said Cameron.
Staying well hydrated is essential, as chronic dehydration is a recognized risk factor for recurrent urinary tract infections. Aim to drink two to three liters of water a day.
Additionally, it's important to respond promptly to the urge to urinate—holding it in can create more problems.
Maintaining regular bowel movements and incorporating a diet rich in prebiotic foods can also support healthy fecal flora.
Non-antibiotic treatments for UTIs
Beyond antibiotic treatments, non-antibiotic approaches to managing UTIs are increasingly being recognized for their effectiveness in reducing recurrence and supporting overall urinary health.
Cranberry supplements have recently gained attention for their effectiveness in preventing UTIs, particularly among women.
High-quality supplements should contain soluble proanthocyanidins—flavonoids with anti-inflammatory properties–at high concentrations.
Cameron notes that not all cranberry products are equally effective; powdered cranberry capsules often lack the potency needed to be impactful.
While some might consider drinking cranberry juice instead of taking a supplement, this approach requires consuming a substantial amount—up to 600-700 calories daily—to achieve the necessary concentration.
In addition, Cameron commonly prescribes methenamine hippurate. "This prescription antiseptic duo prevents bacteria from reproducing and is well tolerated and doesn't contribute to antibiotic resistance, unlike classic prophylactic antibiotics."
Cameron advises exercising caution with taking the popular supplement, D-mannose.
"While it's marketed as a sugar pill that prevents bacterial infections, it's not really effective and it's costly. And, notably, the American Urological Association has not included D-mannose in its recommendations for UTI prevention."
A vaccine on the horizon
Numerous injectable vaccines have been launched in the past, yet most have failed to demonstrate a significant reduction in UTI occurrences, often only increasing antibody levels in the bloodstream without impacting infection rates.
However, recent advancements in vaccine research offer new hope.
Led by J. Curtis Nickel, M.D., of Queen's University, a Canadian team pioneered a sublingual vaccine known as MV140.
This daily treatment over three months targets the mucosal immune response, essential for combating UTIs.
The team conducted early trials in Spain and Canada, and yielded impressive results, showing a 60-70% reduction in UTI occurrences.
Side effects have been minimal, primarily consisting of mild lip tingling and mouth irritation.
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How To Treat & Prevent Urinary Tract Infections In Cats
The first thing that most cat families recognize when their cat has a urinary tract infection is straining in the litter box, urinating outside the box, or not being able to urinate at all. Some will also notice the cat is in pain and licking excessively, but litter box problems are much more common.
Not all cats with urinary tract symptoms like straining have an infection, however. The hard part is telling which cats have bacterial cystitis (a urinary tract infection), which have idiopathic cystitis, and which are just urinating outside the box for behavioral reasons. An infection is a lot less common than the other causes.
About a third of all cats with urinary infections have chronic kidney disease, diabetes, or hyperthyroidism (1). Other causes may just be cats licking out of boredom, as the most common infection is E. Coli and other bacteria from the cat's GI tract—or a dirty litter box that the cat does not want to use, and the infection is from the environment.
Related: Cat Urinary Tract Infection Home Remedies
Finding Out If Your Cat Has an InfectionThe first step to finding out if this is really an infection is to take your cat to your local veterinarian and have a urinalysis done. The urinalysis will let the vet know the following:
if your cat is passing blood, even if you cannot see it,
if there are crystals in the urine,
if your cat is concentrating the urine or there is protein (as seen in kidney disease),
if there is glucose and waste products from the liver,
and of course, if the urine has a pH that supports the growth of bacteria.
If you do not have a veterinarian available or cannot afford to take your cat in for the symptoms of an infection, urinalysis test strips can be purchased for about half the price of a urinalysis. Test strips should really only be used to screen for a problem. If you have to use the test strips, the technician will not examine the urine under the microscope, so the exam will be incomplete.
Normal cats have sterile urine. If bacteria are found in your cat's urine, the pet needs to be treated.
Treating a Urinary InfectionTreatment is usually very effective and can include the following:
1. Providing More Water With Canned FoodThis may be a prevention method too, but it is something many people do not want to resort to because it is inconvenient. The first step is to stop giving dry food at all and provide only canned food or the moist food from pouches.
Yes, I do realize that dry food can be left out all day (which is one reason cats are more obese than ever) and canned is more expensive than dry. Eating fast food three times a day is also more convenient than cooking meals for some people, but the health risks do not justify that action, and there is no good reason to give your cat dry food.
2. Providing More Water With Fountains and Fresh WaterIn the wild, cats obtained most of their fluids from their prey (moist food), and when they did find a water source, if it was warm and brackish, they would avoid it. In your house, if your cat only has a water dish that you only change once a day, it is not surprising that he or she will not drink.
You can encourage water consumption by providing a water fountain (fresh moving water at all times), providing multiple water dishes around the house, and dropping an ice cube into the water dish in the kitchen every time you go there.
3. Providing Water Immediately by Giving FluidsSome veterinarians will recommend fluids for cats with an infection, as they often come in mildly dehydrated. Fluids are especially important if all you have in your house is a single water bowl.
4. Offering an Alternative DietIf your veterinarian also noticed crystals in your cat's urine in the urinalysis, as well as the bacteria, they might recommend a prescription diet. If this alternative is too expensive or you do not want to feed processed food, there are also recipes available for a homemade diet for cats with urinary crystals.
5. Trying (Certain) Herbal SupplementsNone of the studies of Chinese herbal supplements have shown any improvements for cats with an infection, and none of the homeopathic "cures" sold by pet shops are going to help your cat. There is some evidence, however, that cranberry extract can reduce the length of time that your cat has an infection (2).
6. Giving Anti-InflammatoriesThese medications may be prescribed to help with the pain. Even if your cat does not seem to be in pain, they can help, as even mild pain delays the time it takes to heal from any disease.
7. Using the Prescribed AntibioticsYour veterinarian will probably prescribe antibiotics to use immediately for the most likely cause of the infection, but they will usually recommend a culture and sensitivity test to determine the most effective antibiotic to clear up the infection.
Even if your cat responds to the first antibiotic and gets better in just a few days, you should finish the antibiotics so the infection is less likely to come right back. Your veterinarian may change the antibiotic when the culture and sensitivity test comes back, so be sure to fill the new prescription and give those meds for the full course.
After the medications are finished, you should have your cat's urine checked again just to make sure that it has cleared up. If your cat comes down with another urinary infection in a month or two and you didn't have the urine checked after treatment, it may be the same infection.
Related: Why Does My Cat Need to Drink More Water on Pain Meds?
Will My Cat Get Another Infection?Some cats are predisposed to a second urinary infection. Female cats have a shorter urethra, and bacteria are more likely to make it up to the bladder.
If your cat has another health problem (chronic kidney disease, for example), she is even more likely to develop another infection. Cats with urinary crystals that have formed into stones are also more likely to develop another infection.
Others are predisposed to urinary problems even without a bacterial infection, and male cats are more likely to become blocked (and not even be able to urinate) since their urethras are smaller than those of females.
Preventing a Urinary InfectionIncrease water consumption: Keep a water fountain and make sure that it is full and running so the water will be fresh.
Change the diet: To prevent another infection or any urinary problem, you can keep your cat on a prescription diet. The urine will need to be rechecked periodically to ensure that other types of crystals are not forming.
Manage the litter box(es): Always keep at least two or three litter boxes if you have more than one cat. You may not notice them fighting, but the more dominant cat can claim the box and not allow the other cat to use it.
Provide a hiding place so that your cat can flee from any visitors or dogs in the house.
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Related: Why Is My Cat Peeing in My Bed?
SourcesDorsch R, Teichmann-Knorrn S, Sjetne Lund H. Urinary tract infection and subclinical bacteriuria in cats: A clinical update. J Feline Med Surg. 2019 Nov;21(11):1023-1038. Doi: 10.1177/1098612X19880435. Epub 2019 Oct 10. PMID: 31601143; PMCID: PMC6826873. Https://pmc.Ncbi.Nlm.Nih.Gov/articles/PMC6826873/
Colombino E, Cavana P, Martello E, Devalle V, Miniscalco B, Ravera N, Zanatta R, Capucchio MT, Biasibetti E. A new diet supplement formulation containing cranberry extract for the treatment of feline idiopathic cystitis. Nat Prod Res. 2022 Jun;36(11):2884-2887. Doi: 10.1080/14786419.2021.1925273. Epub 2021 May 27. PMID: 34039227. Https://pubmed.Ncbi.Nlm.Nih.Gov/34039227/
GLP-1 Receptor Agonists May Have Broader Range Of Benefits, Risks
Glucagon-like peptide 1 receptor agonists (GLP-1RAs) may have a wider range of benefits and risks than what the medical community currently understands.
In a discovery study, investigators generated an atlas of associations with GLP-1RA initiation versus use of sulfonylureas, dipeptidyl peptidase 4 (DPP4) inhibitors and sodium-glucose cotransporter-2 (SGLT2) inhibitors. They followed 1,955,135 patients treated for diabetes or obesity within the Veterans Affairs health system for a median 3.68 years. The study population, which had a mean age of 68.26 years, was 94.72% male, 71.19% White, 18.46% Black, and 10.40% other races.
Among 175 health outcomes, GLP-1RAs were linked with various protective effects. GLP-1RA use vs usual care was significantly associated with a reduced risk of substance use and psychotic disorders, seizures, neurocognitive disorders (including Alzheimer disease and dementia), coagulation disorders, cardiometabolic disorders, infectious illnesses and several respiratory conditions, Ziyad Al-Aly, MD, of Washington University in St. Louis, Missouri, and colleagues reported in Nature Medicine. Despite earlier concerns, the findings showed that GLP-1RA use reduced the risk of suicidal ideation, attempt or intentional self-harm. With respect to seizures, emerging data indicate GLP-1RA had anticonvulsant properties. GLP-1RAs also might be a useful a primary or adjuvant therapy for various substance use disorders, psychotic disorders and depressive disorders, the investigators suggested.
With respect to risks, GLP-1RA use was significantly associated with an increased risk of gastrointestinal disorders, hypotension, syncope, arthritic disorders, drug-induced pancreatitis, and other conditions, Dr Al-Aly's team reported.
Nephrologists in particular should know that GLP-1RAs might increase the risk for kidney stones and interstitial nephritis. In line with practice-changing trial data, GLP-1 RA reduces cardiovascular and renal outcomes, such as risks for heart failure, chronic kidney disease, acute kidney injury, and major adverse cardiovascular events. These agents also lower the risk for urinary tract infection, septicemia, and bacterial infections, the investigators reported. Obesity is a risk factor for thromboembolic disease, whereas GLP-1RAs have shown anti-thromboembolic effects.
GLP-1RA use may raise the risk of hypotension and syncope. According to Dr Al-Aly's team, careful monitoring of blood pressure and adjustment of antihypertensive medications may be needed.
GLP-1 RA use also may reduce the risks for hepatic failure, inflammatory bowel disease, diverticulitis, and obesity-related cancers attributable to their metabolic and anti-inflammatory properties, the investigators reported.
"The results provide insights into the benefits and risks of GLP-1RAs and may be useful for informing clinical care and guiding research agendas," Dr Al-Aly's team wrote.
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