A. Lenore Ackerman, MD, on non-antibiotic options for UTI prophylaxis

The American Urological Association, in collaboration with the Canadian Urological Association and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, recently released an amendment to the guideline on recurrent uncomplicated urinary tract infections (uUTIs) in women.¹ The amendment specifically includes an expansion of non-antibiotic options for UTI prophylaxis

In a recent interview with Urology Times®, guideline amendment chair A. Lenore Ackerman, MD, PhD, outlines what the data suggest about these approaches, as well as how they should be positioned when counseling patients. Ackerman is a urogynecologist at the University of California, Los Angeles.

Specifically, the guidelines now advise clinicians to offer cranberry, methenamine hippurate, and increased water intake for patients with a water intake below 1.5 L (50 oz) per day as prophylaxis options for women with recurrent UTIs. Additionally, the guidelines recommend that women be counseled that D-mannose alone for prophylaxis may not be effective in UTI prevention.

Ackerman explained that while the data isn’t completely certain on the benefits of these approaches, there is data to suggest that they may be at least non-inferior in efficacy to low-dose prophylactic antibiotics for UTIs, and they pose little risk to patients. Coupled with the fact that antibiotics do pose risks at both the individual and population levels, and knowing that patients are oftentimes frustrated with the amount of antibiotics they are given for UTIs, these approaches should be considered as prophylactic options for these patients.

“The other thing to remember is that no decision is ever, at least in this world, final,” Ackerman concluded. “A patient can decide to try with cranberry, and if that's not working with them, they can change to a different, alternative form of prophylaxis.”

REFERENCE

1. Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2025). American Urological Association. Accessed September 4, 2025. https://www.auanet.org/guidelines-and-quality/guidelines/recurrent-uti