Mode
Text Size
Log in / Sign up

Intravesical aminoglycoside instillations reduce recurrent urinary tract infection risk with an IRR of 0.23New findings show ways to reduce recurring urinary tract infections

AI-generated summary of the cited source, checked by automated accuracy review. How we work

Key Takeaway
Consider intravesical aminoglycoside instillations as a highly effective intervention for reducing UTI recurrence.

This systematic review and meta-analysis of 25 studies evaluates the efficacy of various intravesical instillations for patients with recurrent urinary tract infections (rUTIs), including both neurogenic and non-neurogenic populations. The analysis focuses on aminoglycosides, hyaluronic acid (HA) monotherapy, and HA combined with chondroitin sulphate (CS).

Aminoglycoside instillations demonstrated a marked reduction in UTI recurrence with an IRR of 0.23 (95% CI 0.15-0.37; P < 0.001). HA monotherapy was also found effective for reducing recurrence, reporting an RR of 0.15 (95% CI 0.05-0.43; P = 0.011). In contrast, the pooled effect for HA and CS combined therapy was imprecise, with an RR of 0.41 (95% CI 0.04-4.77; P = 0.465).

The authors noted several limitations, including high heterogeneity for HA monotherapy and inconsistent methods or outcome definitions for heparin, povidone-iodine, and fosfomycin. While intravesical instillations appear safe with mild and infrequent adverse events, the evidence for combined therapies requires further study. Aminoglycosides currently provide the strongest evidence for preventing rUTIs, while HA offers a non-antibiotic alternative.

How this fits prior evidence

This meta-analysis addresses a gap in managing recurrent urinary tract infections (rUTIs) by evaluating intravesical instillations. While previous coverage noted high rates of antibiotic resistance in K. pneumoniae and the prevalence of multidrug resistance in dental unit waterlines, this study provides specific evidence for local interventions to manage rUTI recurrence. Aminoglycosides showed a marked reduction in recurrence with an IRR of 0.23, while HA monotherapy provided an RR of 0.15.

Living with a recurring urinary tract infection (UTI) can be frustrating and difficult to manage. New research looked at different ways to treat these infections by putting medicine directly into the bladder, a process called intravesical instillation. This approach aims to stop the cycle of infections from coming back.

The study looked at 25 different reports to see what worked best. They found that using aminoglycosides (a type of antibiotic) significantly reduced how often infections returned. They also found that hyaluronic acid, which is a substance naturally found in the body, was effective on its own as an alternative to antibiotics.

While these treatments were generally safe and only caused mild side effects, some combinations are still hard to measure clearly. For example, combining hyaluronic acid with chondroitin sulphate showed less consistent results. Because of these inconsistencies, more research is needed for certain combination therapies.

What this means for you:
Aminoglycosides and hyaluronic acid show promise in reducing the number of repeat urinary tract infections.

Common questions

What are the most effective ways to stop a recurring UTI?

The study found that using aminoglycoside instillations led to a marked reduction in how often infections returned. These were among the strongest options for preventing repeat infections. You should talk to your doctor about whether this specific treatment is right for your medical history.

Is there a non-antibiotic option for recurring UTIs?

Yes, hyaluronic acid monotherapy was found to be effective at reducing the rate of infection recurrence. This provides an alternative for patients who may need different options beyond standard antibiotics.

Are these bladder treatments safe for patients?

The study reported that these intravesical instillations were generally safe, with only mild and infrequent side effects noted. However, you should always consult your healthcare provider to discuss the specific risks and benefits of any treatment.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJul 2026
View Original Abstract ↓
OBJECTIVE: To undertake a systematic review and meta-analysis to evaluate the efficacy, safety, and clinical applicability of intravesical instillations for preventing recurrent urinary tract infections (rUTIs). METHODS: PubMed/MEDLINE, Embase, Cochrane CENTRAL, Scopus, and Web of Science were searched from January 2000 to April 2025 for randomised and observational studies of intravesical instillations in rUTI treatment. The primary outcome was UTI recurrence, expressed as incidence rate ratio (IRR) or risk ratio (RR). Random-effects meta-analyses were performed for three intervention families: aminoglycosides, hyaluronic acid (HA) monotherapy, and HA with chondroitin sulphate (HA + CS) combined therapy. Subgroup analyses examined population type and antibiotic used; sensitivity analyses included leave-one-out re-estimation. Other agents were narratively synthesised. RESULTS: Total of 25 studies were included. Aminoglycoside instillations produced a marked reduction in recurrence (pooled IRR 0.23, 95% confidence interval [CI] 0.15-0.37; P < 0.001), with consistent benefit across neurogenic and non-neurogenic populations and across gentamicin and amikacin. HA monotherapy was also effective (pooled RR 0.15, 95% CI 0.05-0.43; P = 0.011), although heterogeneity was high. HA + CS combined therapy showed favourable results in individual studies but an imprecise pooled effect (RR 0.41, 95% CI 0.04-4.77; P = 0.465). Narrative evidence for heparin, povidone-iodine and fosfomycin suggested potential benefit, but methods and outcome definitions were inconsistent. Serum aminoglycoside levels were undetectable where measured, and adverse events were mild and infrequent. CONCLUSION: Intravesical instillations appear safe and effective for preventing rUTIs in select patients. The strongest evidence supports aminoglycosides while HA offers a non-antibiotic alternative. HA + CS requires further study. Larger, high-quality randomised trials with standardised outcomes are needed to optimise protocols and patient selection.
Free Newsletter

Clinical research that matters. Delivered to your inbox.

Join thousands of clinicians and researchers. No spam, unsubscribe anytime.