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Urinary Tract Infection Alternatives

October 10, 2012 Written by JP    [Font too small?]

A new study appearing in the journal Archives of Internal Medicine has the potential to change the way urinary tract infections are treated from this point forward. In the 12 month trial, specific probiotics (Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14) were compared with antibiotic therapy for the prevention of recurrent urinary infections. The test subjects in the experiment were a group of 252 postmenopausal women. The results of the research determined that supplemental probiotics were almost as effective as prescription antibiotics. By “almost”, I mean about -13.8% less effective. However, probiotic therapy features a significant advantage over antibiotic treatment – it doesn’t lead to antibiotic resistance. With antibiotic resistance, patients and physicians encounter difficulties managing both minor and serious infections. This is why preserving antibiotics for truly essential purposes is of the utmost importance.

The use of probiotics for urinary tract infections (UTIs) isn’t exactly groundbreaking. In the past, several studies have demonstrated the efficacy of a probiotic strain known as Lactobacillus crispatus (Lactin-V) in the prevention and treatment of recurrent UTIs in women. What makes the latest research most compelling is that it utilized an oral probiotic supplement. Prior studies, involving female participants, only tested the L. crispatus probiotic in the form of a vaginal suppository. In a real world setting, oral supplements tend to promote greater adherence and tolerability than “medications” administered through other means.

Currently, the biggest controversy regarding a natural approach to UTIs is the role of cranberry juice. In the scientific literature, some studies show positive results when cranberry juice or concentrated cranberry extracts are given to patients with recurrent UTIs. Other trials failed to find a statistically meaningful reduction in UTI occurrence or severity. Based on my understanding of the data, the daily use of pure, unsweetened cranberry juice and clinically-validated cranberry extracts provide the best option here. If the thought of drinking cranberry juice on an ongoing basis doesn’t appeal to you, I would consider an encapsulated extract sold commercially as Cran-Max. Another option is to look for cranberry products that also include an anti-UTI sugar called D-mannose. There is a good deal of anecdotal evidence to support its use, but very little in the way of clinical trials. A general, preventive dosage that is believed effective and safe is approximately 500 mg of Cran-Max and 1,000 mg of d-mannose twice-daily. A higher and more frequent dose of d-mannose is often recommended by naturopathic physicians when a UTI is present and antibiotics aren’t required.

Regarding the long term management of UTIs, it’s important to first address possible causes that are easily modifiable. Topping the list of helpful changes are: 1) ensuring proper hydration; 2) making sure to clean carefully after using the restroom – wiping from “front to back”; 3) urinating soon after intercourse; 4) replacing any questionable feminine products – opting for natural alternatives available in health food stores; 5) living an immune enhancing lifestyle that includes adequate sleep, a nutritious diet and regular stress management. A nutrient dense diet, along with a daily multivitamin and mineral may be especially important. Recent studies reveal that at-risk populations, such as diabetics and pregnant women, can dramatically lower the risk of UTIs by simply increasing the intake of essential nutrients, including Vitamin C from dietary and supplemental sources.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Click on the following links to learn more about the studies referenced in today’s column:

Study 1 – Lactobacilli vs Antibiotics to Prevent Urinary Tract Infections (link)

Study 2 – Randomized, Placebo-Controlled Phase 2 Trial of a Lactobacillus(link)

Study 3 – Phase I Trial of a Lactobacillus Crispatus Vaginal Suppository (link)

Study 4 – A Pilot Study Evaluating the Safety and Effectiveness of Lactobacillus (link)

Study 5 – Cranberry Juice for the Prevention of Recurrent Urinary Tract(link)

Study 6 – Cranberries vs Antibiotics to Prevent Urinary Tract Infections (link)

Study 7 – Novel Concentrated Cranberry Liquid Blend, UTI-STAT With Proantinox (link)

Study 8 – Effect of D-Mannose and D-Glucose on Escherichia Coli Bacteriuria (link)

Study 9 – Micronutrients Decrease Incidence of Common Infections in Type 2 (link)

Study 10 – Daily Intake of 100 mg Ascorbic Acid as Urinary Tract Infection (link)

Cranberry Extracts Do Not Promote Antibiotic Resistance

Source: Arch Intern Med. 2011;171(14):1270-1278. (link)

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Posted in Alternative Therapies, Nutritional Supplements, Women's Health

10 Comments & Updates to “Urinary Tract Infection Alternatives”

  1. S. Satveit Says:

    Thanks for sharing JP. That is positive news and great information.

    I just wanted to mention that women with low estrogen levels, including post menopausal women, can be prone to recurring UTI’s due to the lining of the urethra becoming thin. Balancing hormones is another natural way to prevent UTI’s in women who have low estrogen levels.

    Great blog, btw.


  2. JP Says:

    Thank you for adding that, SS.

    Even conventional practitioners are beginning to accept this option:


    Be well!


  3. Ted Hutchinson Says:

    I have a non functioning bladder so have to self-catherize to pee so insert a foreign body into a sterile area 5 times daily so was prone to repeat UTI. Tried long term low dose AB’s, short high dose and long term high dose and eventually built up antibiotic resistant E Coli and ran out of effective oral AB’s.

    So used Vitamin D Stoss therapy to hit the infection with a short sharp shock (and avoid having to be hospitalized to have a intravenous AB) and followed up ever since with effective strength D3 to keep 25(OH)D around the 125nmol/l 50ng/ml level.

    Science supporting the use of D3 for UTI here.

    Vitamin D Induction of the Human Antimicrobial Peptide Cathelicidin in the Urinary Bladder.

    Antimicrobial Peptides, Innate Immunity, and the Normally Sterile Urinary Tract

    I think that using several strategies to prevent UTI is likely to be more successful than putting all your eggs in one basket. I also drink GREEN TEA, Cranberry and D Mannose if I have any doubts about the clarity/cloudiness of my pee.

    Been over 5 years now since an antibiotic so or UTI so while it’s still fingers crossed I’m confident that it’s possible to prevent UTI in everyone, even those who have to rely on catheters.

  4. JP Says:

    Excellent advice and information, Ted. Thanks a lot for sharing your successful protocol with us.

    Be well!


  5. Alicia Says:

    Many of us have heard of using cranberry juice or supplements to protect against urinary tract infections, but I had not heard of using probiotics! Due to this information, I decided to look up the data on naturalstandard.com and found that cranberries have received an evidence grade of B, or good scientific evidence, from Natural Standard, while probiotics have received an evidence grade of B, or unclear scientific evidence for UTI. This correlates well with what is portrayed in this blog post. As a pharmacy student, I feel that it is important to properly educate and counsel patients on all medications, whether prescription, over the counter, or herbal supplements. One thing that this article explicitly stated is that daily use of “pure, unsweetened cranberry juice and clinically-validated cranberry extracts provide the best option here”. Many patients may hear cranberry juice, and pick up a bottle of cranberry juice cocktail, which is more sugar than anything else. It is really important to state that purity matters for the maximum benefit. Thank you for including this information so that all readers can make informed choices!

  6. JP Says:

    Thank you, Alicia. I appreciate your comments!

    Be well!


  7. JP Says:

    Update: Cranberries also reduce the build up of harmful oral bacteria …


    Contemp Clin Dent. 2015 Jan-Mar;6(1):35-9.

    Comparative assessment of Cranberry and Chlorhexidine mouthwash on streptococcal colonization among dental students: A randomized parallel clinical trial.

    BACKGROUND: Chlorhexidine gluconate mouthwash has earned an eponym of the gold standard against oral infections, but with certain limitations. There is no effective alternative to Chlorhexidine. Cranberry is known to inhibit bacterial adhesion in various systemic infections and acts as a strong antioxidant. However, it is less explored for its dental use. Hence, there is a need to evaluate its effect against oral infections.

    AIM: The aim was to compare the efficacy of 0.2% Chlorhexidine mouthwash with 0.6% Cranberry mouthwash on Streptococcus mutans.

    MATERIALS AND METHODS: This was a double-blind, randomized parallel group clinical trial. Total sample of 50 subjects, aged 18-20 years, were randomly divided into two groups, Group A (25) and Group B (25) were given 10 mL of Chlorhexidine mouthwash and Cranberry mouthwash twice daily, respectively, for 14 days each. The plaque samples, which were taken from the subjects on 1(st) day and 14(th) day, were inoculated on blood agar plates and incubated at 37°C for 24-48 h. Number of streptococcal colony forming units were calculated using digital colony counter. The data were subjected to paired t-test and unpaired t-test at a 5% significance level.

    RESULTS: (1) Chlorhexidine mouthwash showed 69% reduction whereas Cranberry mouthwash showed 68% reduction in S. mutans count. (2) No significant difference was seen between Chlorhexidine and Cranberry mouthwash on streptococci.

    CONCLUSION: Cranberry mouthwash is equally effective as Chlorhexidine mouthwash with beneficial local and systemic effect. Hence, it can be used effectively as an alternative to Chlorhexidine mouthwash.

    Be well!


  8. JP Says:

    Updated 04/24/17:


    J Altern Complement Med. 2017 Apr 17.

    Effect of a Food Supplement Containing L-Methionine on Urinary Tract Infections in Pregnancy: A Prospective, Multicenter Observational Study.

    OBJECTIVE: Adjuvants or alternatives to antibiotics in urinary tract infections (UTIs) during pregnancy seem advisable because of possible fetal stress. The present study assessed the effectiveness of a food supplement containing L-methionine and Hibiscus sabdariffa L. and Boswellia serrata Roxb. extracts as a treatment for symptomatic UTIs in pregnancy.

    DESIGN: Pregnant patients with symptomatic cystitis were screened for UTIs in three different clinical centers. Those unwilling to take antibiotics were offered two alternative treatments: (A) a 1-week treatment with the food supplement or (B) a week in which they were advised to increase their fluid consumption to more than 1.5 L daily. After 1 week, group B patients who still had positive urine cultures (UCs) or had no UC performed took the food supplement for an additional week. UCs were performed on all patients at the first visit (w0) and on most of them at 7 days (w1). Patients who were still positive at w1 or had no UC performed at w1 had UC performed 14 days (w2) thereafter.

    RESULTS: Of 264 pregnant women enrolled, 216 joined group A, while 48 joined group B. At w1, 70.0% of group A patients and 43.2% of those in group B had negative UCs (p = 0.003). The reduction of bacterial load was 42.2% ± 8.0% and 4.5% ± 9.2%, respectively (p < 0.0001). At w1, symptoms disappeared in 135 patients (62.5%) in group A and 22 patients (45.8%) in group B (p = 0.03). At w2, 30 of 32 group B patients who switched to taking the supplement for the second week had negative UCs, including 20 who had been positive at w1. At w2, all group A patients had negative UCs. No side effects were reported. CONCLUSIONS: The food supplement provided effective treatment and might be an adjuvant or alternative to antibiotic therapy of symptomatic UTI in pregnancy. Be well! JP

  9. JP Says:

    Updated 06/17/17:


    Minerva Ginecol. 2017 Aug;69(4):336-341.

    [Evaluation of the effects of a natural dietary supplement with cranberry, Noxamicina® and D-mannose in recurrent urinary infections in perimenopausal women].

    BACKGROUND: The female genital apparatus, the urinary tract and the perineal supporting tissues share a common embryological origin, whose differentiation depends on the action of estrogens. In adult women, the progressive decline of the ovarian function, with the ensuing estrogen deprivation, reduces tissue tropism causing urogenital atrophy, which makes these organs much more susceptible to traumatisms and urinary infections. The disorders associated with changes in the urogenital tract of peri- and postmenopausal women have significant clinical relevance, both on account of their chronicity and high frequency of occurrence and on account of their having major repercussions on the quality of life of the women, who often have to call their doctor seeking relief for their symptoms. In general, these patients report having a significant number of episodes of cystitis per year. With a view to verifying whether the use of a new dietary supplement (Kistinox® Forte sachets) containing cranberry (Vaccinium macrocarpon), Noxamicina® (propolis extract) and D-mannose can be of use in the treatment of cystitis, with or without bacteriuria, through the elimination of urinary symptoms, a multicenter clinical study was conducted on 150 women aged 40 to 50 suffering from recurrent episodes of cystitis as attested by at least one positive urine culture during the six months preceding their recruitment.

    METHODS: The subjects were randomly assigned to two groups: Group A: 100 women were given Kistinox® Forte, 1 sachet per day during the first 10 days of the month, for 3 months; Group B: 50 women did not receive any treatment to serve as a control group.

    RESULTS: The results of the present study show a complete remission of urinary symptoms in 92 women; a slight decrease in urinary symptoms was observed in 5 subjects, whereas 3 women who stopped the treatment after the first cycle were considered drop-outs.

    CONCLUSIONS: This multicenter clinical study revealed the excellent efficacy and tolerability of Kistinox® Forte sachets in the treatment and prevention of urinary disorders in peri- and postmenopausal women. The posology of a sachet a day during the first 10 days of the month for 3 months was well tolerated by the patients, who did not report any disorder arising from the product.

    Be well!


  10. JP Says:

    Updated 11/21/18:


    Open Access Maced J Med Sci. 2018 Oct 20;6(10):1845-1850.

    Probiotics Improve Urogenital Health in Women.

    BACKGROUND: Urogenital recurrent infections represent a global medical issue in the world, affecting millions of women because of dramatic shifts in bacterial composition and concentrations in response to numerous endogenous and exogenous factors. Urogenital microbiota forms a mutually beneficial relationship with their host and has a major impact on health and disease.

    AIM: This study aimed to compare probiotic therapy versus placebo in Oxidative Stress Values (OSVs) and histological features in urogenital infections in female patients.

    METHODS: Forty (n = 40) patients diagnosed with recurrent urogenital infections were recruited to be treated as test group (n = 20), receiving Probiotics, and a control group (n = 20), receiving looking similar placebo, both for 90 days. Both the groups were assessed for total oxidant capacity (d-ROMs test) and biological antioxidant potential as iron-reducing activity (BAP test) at baseline, after 1 and 3 months. Histological changes on inner vaginal mucosa were also investigated, during the entire study.

    RESULTS: d-ROM assay clearly showed that the values of the test group were significantly different, thus leading the general health conditions from a state of high oxidative stress to low oxidative stress levels. Increasing of BAP values were more significant, and clinically relevant, in probiotic test group over time.

    CONCLUSION: Our pilot study gave interesting and promising elements to confirm the safety and effectiveness of oral probiotics in preventing/reducing the recurrent urogenital infections by an overall modification of inner vaginal microbiota.

    Be well!


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