Breaking the cycle of recurrent urinary tract infections in women: a network meta-analysis of superior preventive measures

Recurrent urinary tract infections (rUTI) impose a substantial burden, particularly on vulnerable populations, such as women. The importance of effective prevention strategies is crucial in reducing the incidence of rUTI. While various preventive measures are available, there remains a gap in knowledge regarding their effectiveness and safety in clinical practice. This study aims to evaluate various interventions’ performance in reducing the risk of rUTI and safety compared to placebo in healthy women. This network meta-analysis (NMA) was conducted according to the Systematic Reviews and Meta-Analyses Preferred Reporting Items for Systematic Reviews and Meta-Analyses NMA Checklist. A systematic search was performed in Scopus, PubMed, CENTRAL, EBSCO, Hindawi, and ProQuest up to June 14th, 2024. Studies that met our eligibility criteria are qualitatively assessed using the Cochrane Risk of Bias Tool 2. Data analysis was conducted using Rstudio v.4.3.1 with the DerSimonian-Laird random-effects model. The p-value was calculated to rank treatments. There were 6325 samples obtained from 40 journals. Fosfomycin-trometamol is the best intervention in preventing rUTI in women p=0.9965; relative risk (RR)=0.09; 95% confidence interval (CI) 0.05-0.17. Cranberry extract (p=0.62; RR=0.38; 95% CI 0.24-0.60) and nitrofurantoin (p=0.617; RR=0.38; 95% CI 0.27-0.53) have the most evidence with acceptable RR. Combinations of lactobacillus, cranberry, and D-mannose resulted in the lowest count of adverse effects (p=0.7623; RR=0.9; 95% CI 0.06-13.82). Cranberry extract and nitrofurantoin are highly effective in preventing rUTIs in women. Despite the promising performance of fosfomycin-trometamol, further research is needed to confirm its effectiveness. The composition of lactobacillus, cranberry, and D-mannose appears as the safest option to prevent rUTI.