Effect of Increased Daily Water Intake in Premenopausal Women With Recurrent Urinary Tract Infections: A Randomized Clinical Trial
Hooton TM, Vecchio M, Iroz A, Tack I, Dornic Q, Seksek I, Lotan Y
JAMA internal medicine · 115 citations
Review labels
Neutral facts our review recorded about how this study was done. They describe method, never whether we like the result.
How it was studied
- Design
- Randomized controlled trial (indexed by PubMed)
- Studied in
- People
- Main outcome
- Clinical events such as disease or death
Who paid for it
- Funding
- Funding not disclosed
Publication
- Published
- 2018-10-03 · JAMA Intern Med · vol. 178 · issue 11 · p. 1509
- Publisher
- American Medical Association
- Cited
- 271 citations · more than 100% of similar papers · 22.5× the field average
- Impact
- Top 10% most cited in its field
- References
- 49 works
- Access
- Free to read
- Research areas
- Urinary Tract Infections Management · Pelvic floor disorders treatments · Urinary Bladder and Prostate Research
- Keywords
- Medicine, Randomized controlled trial, Urinary system, Confidence interval, Fluid intake, Internal medicine
- MeSH
- humans, urinary tract infections, recurrence, treatment outcome, premenopause, drinking, adult, female, secondary prevention
7 authors
From US, FR
- Thomas M. Hooton · correspondingUniversity of Miami
- Mariacristina VecchioDanone (France)
- Alison IrozDanone (France)
- Ivan TackUniversité Toulouse III - Paul Sabatier; Centre Hospitalier Universitaire de Toulouse
- Quentin DornicDanone (France)
- Isabelle SeksekDanone (France)
Abstract
Importance
Increased hydration is often recommended as a preventive measure for women with recurrent cystitis, but supportive data are sparse.
Objective
To assess the efficacy of increased daily water intake on the frequency of recurrent cystitis in premenopausal women.
Design, setting, and participants
Randomized, open-label, controlled, 12-month trial at a clinical research center (years 2013-2016). Among 163 healthy women with recurrent cystitis (≥3 episodes in past year) drinking less than 1.5 L of fluid daily assessed for eligibility, 23 were excluded and 140 assigned to water or control group. Assessments of daily fluid intake, urinary hydration, and cystitis symptoms were performed at baseline, 6- and 12-month visits, and monthly telephone calls.
Interventions
Participants were randomly assigned to drink, in addition to their usual fluid intake, 1.5 L of water daily (water group) or no additional fluids (control group) for 12 months.
Main outcomes and measures
Primary outcome measure was frequency of recurrent cystitis over 12 months. Secondary outcomes were number of antimicrobial regimens used, mean time interval between cystitis episodes, and 24-hour urinary hydration measurements.
Results
The mean (SD) age of the 140 participants was 35.7 (8.4) years, and the mean (SD) number of cystitis episodes in the previous year was 3.3 (0.6). During the 12-month study period, the mean (SD) number of cystitis episodes was 1.7 (95% CI, 1.5-1.8) in the water group compared with 3.2 (95% CI, 3.0-3.4) in the control group, with a difference in means of 1.5 (95% CI, 1.2-1.8; P < .001). Overall, there were 327 cystitis episodes, 111 in the water group and 216 in the control group. The mean number of antimicrobial regimens used to treat cystitis episodes was 1.9 (95% CI, 1.7-2.2) and 3.6 (95% CI, 3.3-4.0), respectively, with a difference in means of 1.7 (95% CI, 1.3-2.1; P < .001). The mean time interval between cystitis episodes was 142.8 (95% CI, 127.4-160.1) and 84.4 (95% CI, 75.4-94.5) days, respectively, with a difference in means of 58.4 (95% CI, 39.4-77.4; P < .001). Between baseline and 12 months, participants in the water group, compared with those in the control group, had increased mean (SD) urine volume (1.4 [0.04] vs 0.1 [0.04] L; P < .001) and voids (2.4 [0.2] vs -0.1 [0.2]; P < .001) and decreased urine osmolality (-402.8 [19.6] vs -24.0 [19.5] mOsm/kg; P < .001).
Conclusions and relevance
Increased water intake is an effective antimicrobial-sparing strategy to prevent recurrent cystitis in premenopausal women at high risk for recurrence who drink low volumes of fluid daily.
Trial registration
ClinicalTrials.gov identifier: NCT02444975.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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