Daily antibiotic use came out on top when compared with several other strategies for managing recurrent urinary tract infections (UTIs).

Researchers developed a model of recurrent UTI for each management strategy for which at least two adequate trials had been published. The investigators simulated a cohort that experienced three UTIs per year and a secondary cohort that experienced eight UTIs per year.

Five strategies for the prevention and management of recurrent UTIs were analyzed: daily antibiotic (nitrofurantoin [Furadantin, Macrobid, Macrodantin]) prophylaxis, daily estrogen prophylaxis, daily cranberry prophylaxis, acupuncture prophylaxis, and symptomatic self-treatment.

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The nitrofurantoin option proved to be the most effective as well as the most expensive to the payer in the model of three UTIs per year, reducing the UTI rate to 0.4 per year, at an annual cost to the payer of $821. 

The acupuncture recurrence rate was 0.7 per year. The use of cranberry pills brought the recurrence rate to 1.1 per year, as did estrogen therapy. Symptomatic self-treatment did not reduce recurrence rates but was associated with the highest quality of life of all management strategies (all regimens improved this measure).


  1. Eels SJ et al. Clin Infect Dis. 2014;58(2):147-160.