Preventive strategies for recurrent urinary tract infections in premenopausal women: A scoping review

BACKGROUND: Recurrent urinary tract infection (rUTI) in women is common in primary care. Antibiotics can prevent rUTI, but their use is associated with the risk of developing antimicrobial resistance. Thus, non-antibiotic strategies are needed, yet evidence remains limited due to methodologically weak studies. Consequently, potentially effective strategies lack sufficient evidence for guideline inclusion, leaving healthcare professionals (HCPs) and women with little support. This scoping review synthesises preventive strategies for rUTIs in premenopausal women, mapping recommendations and underlying rationales to guide future research and guideline development. METHODS: This Scoping review was conducted by searching PubMed, Cochrane, EMBASE, Web of Science, and CINAHL. 6170 records were identified for eligibility. A total of 78 publications were included, i.e. reviews, guidelines, and expert reports regarding preventive strategies used for rUTIs for premenopausal women, published between January 2013 and December 2023. RESULTS: 78 publications addressed rUTIs prevention in premenopausal women, encompassing both well-studied strategies, such as antibiotic regimens and cranberry products, and less-studied approaches, including behavioural modifications, vitamin supplements, and increased hydration. Recommendations were often unsupported by evidence, and disagreement among sources was common. DISCUSSION: To support women with rUTIs, HCPs require an overview of preventive strategies including supporting recommendations and evidence. Our findings highlight a clear contrast between well-studied strategies, such as antibiotic regimens, and behavioural strategies, where evidence is limited, often because some cannot feasibly be evaluated in randomised trials rather than due to limited clinical relevance. These findings may help HCPs and guideline developers assess evidence and prioritise future research.