OTCs Today
Mary Warner
Urinary tract infections are among the most common bacterial infections, accounting for almost 9 million ambulatory care visits per year. Women are more likely to develop a UTI than men, and one in three women will develop a UTI requiring treatment before they are 24 years old. Although antibiotics are necessary to resolve the infection, nonprescription medications can help resolve symptoms while the antibiotics do their work.
Risk factors and prevention
As mentioned above, UTIs are more common in women than in men because of anatomic differences; women increase their risk of developing a UTI by wiping from back to front after urination. Additional risk factors in women include diaphragm use, sexual intercourse, a history of UTIs, maternal history of UTI, and being postmenopausal. In men, benign prostatic hypertrophy can increase the risk of developing a UTI. Conditions that prevent complete emptying of the bladder can also contribute to development of a UTI.
Increased fluid intake and complete voiding of the bladder have been suggested as ways to prevent UTIs, but research has not proven these routines to be effective. Increased fluid intake may dilute the bacteria in the urinary tract and increase voiding frequency, but it does nothing to prevent a UTI from developing.
What about cranberry juice?
Cranberry juice has long been touted as a way to both prevent and treat UTIs because it contains proanthocyanidins (PACs), substances that can prevent bacteria from sticking to the walls of the bladder and may prevent infections. However, the authors of a Cochrane review published on November 10, 2023, point out the there is no established regimen for PAC dosage and that there is no formal regulation of cranberry products by health care authorities.
The authors of the review analyzed the results of 50 randomized controlled trials involving almost 9,000 patients that compared the occurrence of UTIs in people taking a cranberry product with those taking a placebo or receiving no treatment. They found that taking cranberries as a juice, tablet, or capsule reduced the number of UTIs in women with recurrent UTIs, in children with UTIs, and in people susceptible to UTIs following an intervention such as bladder radiotherapy. However, UTI occurrence did not appear to be reduced in older patients, in adults with neuromuscular bladder dysfunction and incomplete bladder emptying, or in pregnant women.
Few patients reported adverse effects, with the most common being stomach pain. The researchers concluded that further assessment is required to clarify further which patient populations could benefit from cranberry products.
Treating the symptoms
The most common symptoms of a UTI are a strong, frequent urge to urinate; pain or a burning sensation during urination; cramping in the lower back or sides; foul-smelling or cloudy urine; and rectal pain (in men) or pelvic pain (in women).
Nonprescription UTI relief medications are intended to address the symptoms of UTIs while antibiotics are used to treat the underlying infection.
Most of these OTC products contain phenazopyridine hydrochloride, which may alleviate the burning, pain, and constant feeling of having to urinate. Because phenazopyridine hydrochloride is a dye, it usually causes urine to turn a harmless bright yellow or dark orange color. Some kits also contain UTI test strips, but it’s important to note that these do not detect the presence of bacteria, but only measure nitrate, pH, and leukocyte levels, which could indicate a UTI.
What to tell your patients
Ensure that patients understand that nonprescription UTI relief products only relieve the pain and do not treat bacterial infections, and that prescription antibiotic medications are required to eliminate the bacteria, often E. coli, that cause UTIs. Advise patients who suspect a UTI to see their physician as soon as possible for a definitive urine test and appropriate antibiotic treatment. Nonprescription relief products can be used to manage symptoms until the infection has been eliminated. ■