Furthermore, UTIs result in considerable patient morbidity and time off work hence, the management of this condition incurs large financial costs, estimated at $3.5 billion in the USA per year 7, 8. In addition, UTIs are the most common cause of infection in hospitalized patients, accounting for 17.2% of all nosocomial infections in England 6. In 2007, UTI recurrence accounted for 10.5 million outpatient consultations and 2–3 million emergency department visits in the USA alone 5. The incidence of UTI in men is considerably lower than that in women, with an estimated lifetime prevalence of 13.7%. Observational studies have found an average recurrence rate in women of 2.6 infections per year 4. The true incidence is difficult to accurately define (owing to differences in reporting methods and diagnostic criteria), but half of all women have been estimated to experience a UTI in their lifetime, and up to 50% of these will have recurrent infection within the following 6-month period 2, 3. Urinary tract infections (UTIs), which are defined microbiologically as the inflammatory response of the urothelium to microbial pathogens, are among the most common bacterial infections affecting an estimated 150 million people each year worldwide 1. A combination of these agents might provide the optimal treatment to reduce recurrent UTI, and trials in specific population groups are required.
Some of the results of trials of these approaches are promising however, high-level evidence is required before firm recommendations for their use can be made. Potential nonantibiotic measures and treatments for UTIs include behavioural changes, dietary supplementation (such as Chinese herbal medicines and cranberry products), NSAIDs, probiotics, d-mannose, methenamine hippurate, estrogens, intravesical glycosaminoglycans, immunostimulants, vaccines and inoculation with less-pathogenic bacteria. The growing problem of antimicrobial resistance means that the search for nonantibiotic alternatives for the treatment and prevention of UTI is of critical importance. Urinary tract infections (UTIs) are highly prevalent, lead to considerable patient morbidity, incur large financial costs to health-care systems and are one of the most common reasons for antibiotic use worldwide.
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