Effect of Increased Daily Water Intake in Premenopausal Women With Recurrent Urinary Tract Infections

Abstract

is often recommended as a preventive measure for women with recurrent cystitis, but supportive data are sparse. OBJECTIVE To assess the efficacy of increased daily water intake on the frequency of recurrent cystitis in premenopausal women. DESIGN, SETTING, AND PARTICIPANTS Randomized, open-label, controlled, 12-month trial at a clinical research center (years 2013-2016). Among 163 healthy women with recurrent cystitis (Ն3 episodes in past year) drinking less than 1.5 L of fluid daily assessed for eligibility, 23 were excluded and 140 assigned to water or control group. Assessments of daily fluid intake, urinary hydration, and cystitis symptoms were performed at baseline, 6-and 12-month visits, and monthly telephone calls. INTERVENTIONS Participants were randomly assigned to drink, in addition to their usual fluid intake, 1.5 L of water daily (water group) or no additional fluids (control group) for 12 months. MAIN OUTCOMES AND MEASURES Primary outcome measure was frequency of recurrent cystitis over 12 months. Secondary outcomes were number of antimicrobial regimens used, mean time interval between cystitis episodes, and 24-hour urinary hydration measurements. RESULTS The mean (SD) age of the 140 participants was 35.7 (8.4) years, and the mean (SD) number of cystitis episodes in the previous year was 3.3 (0.6). During the 12-month study period, the mean (SD) number of cystitis episodes was 1.7 (95% CI, 1.5-1.8) in the water group compared with 3.2 (95% CI, 3.0-3.4) in the control group, with a difference in means of 1.5 (95% CI, 1.2-1.8; P < .001). Overall, there were 327 cystitis episodes, 111 in the water group and 216 in the control group. The mean number of antimicrobial regimens used to treat cystitis episodes was 1.9 (95% CI, 1.7-2.2) and 3.6 (95% CI, 3.3-4.0), respectively, with a difference in means of 1.7 (95% CI, 1.3-2.1; P < .001). The mean time interval between cystitis episodes was 142.8 (95% CI, 127.4-160.1) and 84.4 (95% CI, 75.4-94.5) days, respectively, with a difference in means of 58.4 (95% CI, 39.4-77.4; P < .001). Between baseline and 12 months, participants in the water group, compared with those in the control group, had increased mean (SD) urine volume (1.4 [0.04] vs 0.1 [0.04] L; P < .001) and voids (2.4 [0.2] vs −0.1 [0.2]; P < .001) and decreased urine osmolality (−402.8 [19.6] vs −24.0 [19.5] mOsm/kg; P < .001). CONCLUSIONS AND RELEVANCE Increased water intake is an effective antimicrobial-sparing strategy to prevent recurrent cystitis in premenopausal women at high risk for recurrence who drink low volumes of fluid daily. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02444975

Access to clean water and urinary tract infections in Haitian women

“…In childhood, it is estimated that 3% of girls and 1% of boys will have a UTI by age 11 years. Factors related to this increased risk for UTIs, which have been found to be significant issues, may be due to hygiene, a lack of knowledge about UTIs, the onset of menstruation, and sexual activity, which have been found to be significant issues (Hooton et al, ; Minardi, d’Anzeo, Cantoro, Conti, & Muzzonigro, ; Moreno, ).…”

“…For example, it is estimated that 60% of women will have at least one urinary tract infection (UTI) in their lifetime and that nearly 25% of women who suffer an initial UTI will have a recurrent UTI with the same or a different bacterial strain in the following 6 months (O'Brien et al, ). A UTI is defined as any infection in the urinary tract system from organisms, such as Escherichia coli or Staphylococcus saprophyticus that involves the bladder and urethra (Hooton et al, ). Risk factors associated with UTIs include a previous history of UTIs, being female, sexually active, urinary retention, having diabetes, or having an obstruction in the urinary tract.…”

“…Risk factors associated with UTIs include a previous history of UTIs, being female, sexually active, urinary retention, having diabetes, or having an obstruction in the urinary tract. The standard treatment is antibiotics; however, if a UTI is untreated, the infection can spread to the kidneys (pyelonephritis) or elsewhere in the body, causing sepsis which can lead to death (Hooton et al, ; O'Brien et al, ).…”

“…The standard treatment is antibiotics; however, if a UTI is untreated, the infection can spread to the kidneys (pyelonephritis) or elsewhere in the body, causing sepsis which can lead to death (Hooton et al, 2018;O'Brien et al, 2017).…”

A hypothesis for why sodium glucose co‐transporter 2 inhibitors have been found to cause genital infection, but not urinary tract infection

“…On average, the daily urine volume increases by about 1.6‐fold compared with before the medication was started; although this varies by SGLT2 inhibitor use and patient population . The idea that increased urinary flow could play a role is supported by a recent large randomized trial of increased fluid consumption in patients at high risk for UTI, which showed that increased water intake doubled urinary volume and reduced UTIs by approximately 50% over a 12‐month period …”