Increased fluid intake for the prevention of urinary tract infection in adults and children in all settings: a systematic review

  • O. Fasugba
    Corresponding author. Address: Nursing Research Institute, Australian Catholic University & St Vincent's Health Australia Sydney, St Vincent's Hospital, Level 5 DeLacy Building, Victoria Road, Darlinghurst 2010, NSW, Australia. Tel.: +61 2 6209 1325.
    Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital, Melbourne & Australian Catholic University, Australia

    Lifestyle Research Centre, Avondale College of Higher Education, Cooranbong, New South Wales, Australia
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  • B.G. Mitchell
    Faculty of Arts, Nursing, and Theology, Avondale College of Higher Education, Wahroonga, New South Wales, Australia

    School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia
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  • E. McInnes
    Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital, Melbourne & Australian Catholic University, Australia
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  • J. Koerner
    School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Canberra, Australian Capital Territory, Australia
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  • A.C. Cheng
    Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, Victoria, Australia

    School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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  • H. Cheng
    Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital, Melbourne & Australian Catholic University, Australia
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  • S. Middleton
    Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital, Melbourne & Australian Catholic University, Australia
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Published:August 23, 2019DOI:



      Non-antibiotic interventions for urinary tract infection (UTI) prevention have been investigated as a strategy to reduce antibiotic prescribing for UTI and subsequent antibiotic resistance. Increased hydration is widely advocated for preventing UTI; however, evidence for its effectiveness is unknown.


      To systematically review the published literature on the effectiveness of increased fluid intake as a preventive intervention for UTI in adults and children in any setting.


      Five electronic databases were searched from inception to February 2019 to identify published randomized controlled trials (RCTs) and quasi-experimental studies evaluating the effectiveness of high (≥1.5 L/24 h) versus normal/low (<1.5 L/24 h) fluid intake for UTI prevention. The outcome was UTI incidence. Risk of bias was assessed using the Cochrane Collaboration's tool. Due to the small number of studies identified, meta-analysis was not possible. Hence a narrative synthesis was undertaken.


      Of the 2822 potentially relevant papers, two were eligible for inclusion: an RCT (individual randomization) and a cluster-RCT. Both studies differed regarding participants, setting, sample size, UTI definition, and intervention. The RCT was assessed as having a low risk of bias whereas the cluster-RCT had a high risk of bias. Only the RCT, which included healthy premenopausal women visiting primary care clinics, demonstrated statistical significance for the effect of high fluid intake for UTI prevention.


      The lack of enough adequately powered and robust RCTs highlights the need for further research on the effectiveness of this intervention for UTI prevention.


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