Iossa Vincenzo, Masciovecchio Stefano, Clemente Giovanni Battista, Chiaramonti Francesco, Ciotta Cosimo, Pandolfo Savio Domenico, Aveta Achille, Buonopane Roberto, Di Girolamo Antonio, Fiore Felice, Sessa Gaetano, Vitale Raffaele, di Mauro Ernesto, Di Pasquale Alfonso Boris, Imperatore Vittorio
Department of Urology, Azienda Ospedaliera "S.G. Moscati", Avellino, Italy.
Department of Urology, Urology Unit, S. Salvatore Hospital, Coppito, 67100, L'Aquila, Italy.
Int Urol Nephrol. 2025 Aug 25. doi: 10.1007/s11255-025-04747-0.
Recurrent urinary tract infections (rUTIs) are a common and impactful clinical challenge in premenopausal women, significantly affecting quality of life and imposing high healthcare costs. Despite their prevalence, robust comparative studies evaluating preventive strategies are scarce, and growing antimicrobial resistance necessitates exploring non-antibiotic alternatives. The aim of this study is to compare the efficacy and safety of increased hydration, D-mannose, and antibiotic prophylaxis in preventing recurrent UTIs in premenopausal women.
This 12-month, prospective, randomized, controlled, multicenter, three-arm parallel study enrolled 75 premenopausal women (18-49 years) with ≥ 3 UTIs/year. Participants were randomized (1:1:1) to increased hydration, D-mannose, or low-dose antibiotic prophylaxis. Primary endpoints were number of UTI episodes/year. Secondary endpoints included time to first UTI and adverse events. Statistical analysis utilized ANOVA and Kaplan-Meier methods.
All three groups demonstrated some degree of UTI prevention. The antibiotic prophylaxis group showed the lowest rUTI incidence (mean 0.2 episodes/year, median 0), significantly lower than the increased hydration group (mean 1.08 episodes/year, median 1; p < 0.05). D-mannose showed intermediate efficacy (mean 0.32 episodes/year, median 0), trending toward significance compared to increased hydration. Mean time to first UTI was longest in the antibiotic group (4.5 months) vs. D-mannose (2.5 months) and hydration (1 month). Minor adverse events (e.g., mild gastrointestinal issues) were more frequent with antibiotics; no severe adverse events occurred.
Low-dose antibiotic prophylaxis remains the most effective strategy for rUTI prevention in premenopausal women. However, D-mannose emerges as a promising, safe non-antibiotic alternative, demonstrating notable efficacy in reducing episodes. Increased hydration, while less effective, remains a safe, economical, and easily implementable baseline measure. These findings advocate for a personalized approach to rUTI prevention, balancing efficacy, safety profile, and patient preference, particularly to mitigate antibiotic use and combat antimicrobial resistance.
复发性尿路感染（rUTIs）是绝经前女性常见且具有重大影响的临床挑战，严重影响生活质量并带来高昂的医疗成本。尽管其发病率高，但评估预防策略的有力比较研究却很匮乏，而且日益增加的抗菌药物耐药性使得探索非抗生素替代方案成为必要。本研究的目的是比较增加水摄入量、D-甘露糖和抗生素预防在预防绝经前女性复发性尿路感染方面的疗效和安全性。
这项为期12个月的前瞻性、随机、对照、多中心、三臂平行研究纳入了75名每年发生≥3次尿路感染的绝经前女性（18 - 49岁）。参与者被随机（1:1:1）分为增加水摄入量组、D-甘露糖组或低剂量抗生素预防组。主要终点是每年尿路感染发作次数。次要终点包括首次发生尿路感染的时间和不良事件。统计分析采用方差分析和Kaplan-Meier方法。
所有三组都显示出一定程度的尿路感染预防效果。抗生素预防组的复发性尿路感染发病率最低（平均每年0.2次发作，中位数为0），显著低于增加水摄入量组（平均每年1.08次发作，中位数为1；p < 0.05）。D-甘露糖显示出中等疗效（平均每年0.32次发作，中位数为0），与增加水摄入量组相比有显著趋势。首次发生尿路感染的平均时间在抗生素组最长（4.5个月），而D-甘露糖组为（2.5个月），增加水摄入量组为（1个月）。抗生素组的轻微不良事件（如轻度胃肠道问题）更常见；未发生严重不良事件。
低剂量抗生素预防仍然是预防绝经前女性复发性尿路感染最有效的策略。然而，D-甘露糖作为一种有前景的、安全的非抗生素替代方案出现，在减少发作次数方面显示出显著疗效。增加水摄入量虽然效果较差，但仍然是一种安全、经济且易于实施的基线措施。这些发现提倡采用个性化方法预防复发性尿路感染，平衡疗效、安全性和患者偏好，特别是为了减少抗生素使用并对抗抗菌药物耐药性。
