How do I treat a UTI? What treatments and supplements are there?

Nobody likes getting UTIs, and if you’ve suffered more than once, you would probably do anything to avoid another. It's worth figuring out what your triggers are and why you keep getting recurring UTIs in order to do your best to avoid them but also use the right products for you during high risk situations to help prevent them from happening and so you can go about your day to day life.  There are a range of solutions out there, from prescribed antibiotics to probiotics to cranberry juice.

Your healthcare provider (HCP) should be your first stop when you have an infection, and you will likely be prescribed antibiotics for a few days to clear it. This often works for clearing one-off infections, but if you suffer recurrently, the bacteria are more likely to become resistant to antibiotics. The National Institute for Health and Care Excellence (NICE) reported in 2016 that:

"approx. 1/3 of UTI samples were resistant to the commonly prescribed antibiotic, trimethoprim"

Antibiotics often kill your protective lactobacilli in the vagina, leaving you less protected against subsequent infections, such as thrush or bacterial vaginosis. Those who suffer from recurrent infections may take prophylactic (preventive) antibiotics. Your HCP may suggest taking these during “high-risk” activities when you may be at increased risk of developing an infection, e.g. after sex or everyday for a few months in a row.

Hiprex (Methenamine) works by interacting with acid in the urine to produce formaldehyde and kill infecting bacteria in the bladder. For it to work, your urine must therefore be acidic and so you cannot take alkalisers at the same time. Side effects like vomiting, diarrhoea and painful urination have been reported. These, alongside the association with formaldehyde mean that not every HCP will recommend this medication. In 2024 Nice guidelines for antimicrobial prescribing were updated to include Hiprex as well as oestrogen.

Vaginal oestrogen. If your UTIs are most likely a result of perimenopause or menopause you may be offered oestrogen to help manage this. As we discussed in our blog post about the impact of menopause and low oestrogen's impact on the microbiome we know that due to changes in hormone levels, the vaginal walls become thinner, reducing their ability to produce glycogen which helps support healthy bacteria such as lactobacilli. These are needed to maintain the low protective pH everyone is talking about. This increases the risk of recurring UTIs and so in this case oestrogen may be a solution to help improve lactobacilli colonisation and therefore lead to a stronger protective microbiome.

UTI vaccines (e.g. Uromune) are showing promise at protecting against some of the most common UTI-causing bacteria. They are not easily accessible at this point, and there are very mixed reviews on their efficacy, with people reporting that they need to take it continuously. The downside is the poor accessibility of the vaccines and the costs, which are typically covered privately.

Over the counter (OTC) options for managing UTIS

There are numerous products that are more widely available in pharmacies and supermarkets such as:

Cranberry juice is the most common product associated with treating or preventing UTIs at home. This is based on the fact that cranberries contain proanthocyanidins (PACs) that have been shown to prevent bacteria from binding to bladder cells. However, it is unlikely that cranberry juice has the same effect, since it is far less concentrated than the unprocessed fruit, and also contains a lot of sugar. There are many cranberry supplements (concentrated powders and pills) available now that aim to provide the concentrated PACs that may reduce UTI frequency.

D-mannose works in a similar way to PACs, binding to E. coli and preventing the bacteria from attaching to bladder cells. It is in a range of supplements, but its efficacy is not fully determined. Ideally you avoid getting bacteria into the urinary tract and bladder in the first instance.

Alkalisers containing potassium citrate (e.g. Cystopurin) are often recommended to relieve UTI symptoms e.g. burning during urination. They work by neutralizing the acid produced by bacteria growing in the urethra. While alkalisers can relieve the pain when urinating during an infection they don’t fight the harmful bacteria and are hence often given alongside antibiotics to make the symptoms more manageable.

Probiotics are available that claim to improve all aspects of our health, including vaginal and urinary tract health. Most of these contain at least one strain of Lactobacillus bacteria. This is the protective, lactic acid-producing microbe that can keep pathogens from invading. However, a lot of probiotics on the market contain strains of Lactobacillus that do not naturally colonise the vagina. The amount of live, active bacteria in these products is also questionable. If the bacteria are indeed alive, they must survive digestion before reaching the urovaginal tract. There are probiotic suppositories that are inserted into the vagina which may have a more direct impact on the vaginal microbiota. 

When it comes to understanding which solution is best for your personal case, it's always best to consult with a urogynaecologist (or your regular HCP) first to set a personalised treatment plan.  You may also want to do a microbiome test to understand which bacteria is impacting your microbiome to determine the best approach, for example which antibiotics are best suited to target specific bacteria.

If you are concerned about recurring UTIs and are struggling to find the support you need, we have put together a handy list of reliable UTI charities and organisations you may find useful to follow.

Below is a comparison table of the UTI treatments and supplements we discussed in this article. If you have any questions please reach out to us at hello@p-happi.com