Urinary tract infections (UTI) are common occurring in 50-60% of women with a recurrence rate of 30-44% (1,2). It is a major cause of antibiotic prescriptions leading to significant costs to health-services and patients as well as reduction in workforce productivity. 

The primary aim of this study is to survey women’s knowledge of non-antibiotic products in the prevention and treatment of urinary tract infections (UTIs). Also, to gain insight into their experiences and attitudes towards using these products. 

The secondary objective is to gain insight into women’s attitudes towards Complementary and Alternative Medicine (CAM) therapies in general and their perception of healthcare professionals’ attitudes to CAMs.

A cross-sectional questionnaire-based survey was conducted, with women recruited from three main areas: 
Group 1	Women attending a hospital-based tertiary-care clinic for problematic        bladder symptoms
Group 2	Women attending hospital-based tertiary clinics for non-bladder related problems
Group 3	Women responding to a request on social media (with/without bladder problems)

The questionnaire collected data on demography, experiences with UTIs, non-antibiotic treatments women had heard about or used and which worked best. It assessed how women initially discovered these methods and their experiences with seeking advice from healthcare professionals (HCP).

The validated Complementary and Alternative Medicine Beliefs Inventory (CAMBI) tool was used to determine treatment beliefs of women in order to determine how different beliefs relate to specific aspects of CAM use.

A cross-sectional questionnaire-based survey was conducted, with women recruited from three main areas: 
Group 1	Women attending a hospital-based tertiary-care clinic for problematic        bladder symptoms
Group 2	Women attending hospital-based tertiary clinics for non-bladder related problems
Group 3	Women responding to a request on social media (with/without bladder problems)

The questionnaire collected data on demography, experiences with UTIs, non-antibiotic treatments women had heard about or used and which worked best. It assessed how women initially discovered these methods and their experiences with seeking advice from healthcare professionals (HCP).

The validated Complementary and Alternative Medicine Beliefs Inventory (CAMBI) tool was used to determine treatment beliefs of women in order to determine how different beliefs relate to specific aspects of CAM use.

Results:
706 women in total participated; group 1 (n=222), group 2 (n=320), group 3 (n=164). 28%(n=198) of participants were above the age of 60 with mean ages; 63yrs (group 1), 51yrs (group 2), 39 yrs (group 3). As reflected by this age range, more women had previously gone through menopause in group 1 (62%, n=128), while most women had not yet reached menopause in group 3 (74%, n=115). Group 2 was evenly distributed between; currently going through menopause (26%, n=73), previously (30%, n=85) and not yet reached (32%, n=91).

Overall, 65% (427) had not experienced a UTI within the past year. However, a higher proportion in group 1 (22%, n=46) and 3 (24%, n=38) had experienced recurrent (>3) infections within 12 months compared with group 2 (5% n=15). 42% (n=94) in group 1, 62% (n=189) in group 2 and 95%(n=152) in group 3 had tried non-antibiotic therapies, with cranberry products being the most frequently reported in all three groups; group 1 - 86% (n=81), group 2 - 59% (n=179) and group 3 88%(140). Overall, group 3 had tried a greater number of different non-antibiotic therapies (n=46) vs. group 1(n=6) and group 2(n=6).

30% (n=115) of women overall agreed that non-antibiotics helped in the prevention or treatment of a UTI, with 44%(n=171) stating they were unsure. Despite this, 61% would still recommend non-antibiotic products to a friend. 62 women in total specifically stated cranberry products as being useful. 

Typically, women seemed to hear about products most commonly though word of mouth from friends or relatives (32%, n=129) rather than via a healthcare professional (21%, n=84) with 77% (n=386) stating they had not discussed the use of these products with a  HCP. Of those who had had this discussion, 178 (50%) stated the professional was supportive of their use. Those in group 3 were the most keen for additional information about these products from a HCP (69%, n=107). 

Results from the CAM Beliefs Inventory (CAMBI) questionnaire did not drastically differ between groups. 372/522 (71%) of women overall agree treatment should have no negative side effects. 236/538 (44%) believe that treatments should only contain natural ingredients with 462/547 (85%) noting that ingredients should be non-toxic. Importantly, (84%) 378/450 believe that patients should take an active role in treatment. Maintaining overall good health was key with 404/499 (81%) women agreeing treatments should increase their natural ability to stay healthy and 374/469 (80%) agreeing treatments should focus on overall wellbeing.

Women in the younger online cohort, with higher incidence of recurrent UTIs, were more likely to try a greater number of alternative therapies. This group was also the most keen for additional information, demonstrating that there is a strong unmet need for information in those with recurrent infections. 

Women most commonly heard about products through word of mouth and family rather than through a HCP, with the majority of HCPs not having this discussion with patients. There is a perceived unmet need for information on non-antibiotic products to treat/prevent UTIs from HCPs.

Of all the non-antibiotics mentioned, cranberry supplementation (irrespective of mode) was the most commonly tried despite lack of evidence in literature. This survey also highlighted the number of other different therapies available which are not commonly being used or trialed for UTIs. While only one third of women felt non-antibiotic therapies worked, over 60% would still have recommended them to a friend highlighting how keen women were to help each other in these situations.

Irrespective of group, women believed in non-toxic natural complementary therapies treatments and wanted to participate in their own management, suggesting women would be open to using non-antibiotic products for the prevention and treatment of UTIs if an appropriate method was proven to be effective.

To conclude, women desire more information on non-antibiotic products for UTI prevention and treatment, as the majority of HCPs are not engaging in this discussion. There is a vast range of non-antibiotic products available with cranberry being the most popular and perceived as effective by those who had tried it. Women are open to using non-antibiotic products for the prevention and treatment of UTIs.

Gupta K, Trautner B. Diagnosis and management of recurrent urinary tract infections in non-pregnant women. BMJ 2013 May 29;346:f3140.
Lüthje P, Brauner A. Novel strategies in the prevention and treatment of urinary tract infections. Pathogens. 2016;5:E13.