A Review of Nonantibiotic Agents to Prevent Urinary Tract Infections in Older Women

J Am Med Dir Assoc. 2020 Jan;21(1):46-54. doi: 10.1016/j.jamda.2019.04.018. Epub 2019 Jun 18.


Objective: This article provides a comprehensive literature review on nonantibiotic agents used for the prevention of urinary tract infections (UTIs) in women ≥45 years of age.

Design: A structured review was performed by conducting a literature search to identify relevant studies pertaining to the use of nonantibiotic agents to prevent UTIs in women who were perimenopausal through postmenopausal. Recommendations were made for or against the use of each nonantibiotic agent, unless data were unavailable. Levels of evidence were assigned to each recommendation made.

Setting and participants: Studies on the prevention of UTIs with women subjects ≥45 years of age in the community, inpatient, and long-term care settings were considered for inclusion.

Measure: The efficacy and safety of using ascorbic acid, cranberry products, d-mannose, estrogens, lactobacilli, and methenamine hippurate for prevention of UTIs was assessed.

Results: There is evidence to support use of estrogens (A-I) in postmenopausal women, and cranberry capsules (C-I) in women ≥45 years of age for the prevention of UTIs. There was a lack of evidence to make recommendations for or against the use of ascorbic acid, cranberry juice, cranberry capsules with high proanthocyanidin (PAC) content, d-mannose, lactobacillus, and methenamine hippurate in this population.

Conclusions/implications: Current studies support that estrogens and cranberry capsules may have a role in preventing UTIs in women ≥45 years of age. Further research is needed to elucidate the role of these nonantibiotic agents and how they may be used to decrease antibiotic use.

Keywords: Ascorbic acid; cranberry; d-mannose; estrogens; lactobacillus; methenamine hippurate; older adult women; prevention of urinary tract infections.

Publication types

  • Review

MeSH terms

  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Complementary Therapies*
  • Female
  • Humans
  • Phytotherapy
  • Urinary Tract Infections* / drug therapy
  • Urinary Tract Infections* / prevention & control
  • Vaccinium macrocarpon*


  • Anti-Bacterial Agents