1. Foundation — every patient
- Adequate water intake (individualized; often ~2–2.5 L/day)
- Do not defer urination; void after intercourse when applicable
- Avoid spermicides; consider alternative contraception if triggering
- Post-menopausal: discuss vaginal estrogen with your clinician
2. Evidence-informed adjuncts
- Cranberry (PAC-standardized) — reduces recurrence in some populations; look for 36 mg PAC by BL-DMAC method
- D-mannose — 2 g daily has been studied for prevention in women with recurrent E. coli UTIs
- Probiotics — L. rhamnosus GR-1 / L. reuteri RC-14 support urogenital microbiome
- Vitamin D — correct deficiency; general immune support
3. When to escalate
Persistent recurrences deserve urine culture with each event, careful antibiotic selection, and consideration of post-coital, self-start, or prophylactic regimens. Any fever, flank pain, or gross hematuria warrants prompt evaluation.
4. What to expect
A durable UTI plan is layered: behavior + hydration + vaginal health + selective supplements + smart antibiotic strategy. Give the plan 3 months before judging effect.