Review of Over-the-Counter Urinary Tract Infection Products

Objectives: To review the breadth of commercially available over-the-counter products marketed for urinary tract infection (UTI) prevention or symptom relief in order to empower patients to make informed choices.

Methods: The top five drugstores in the United States (US) were identified by utilizing market share data for 2023. Drugstores with an accessible online pharmacy were included in the review. Over-the-counter products marketed for UTI prevention or relief were identified by searching “urinary tract infection,” “urinary tract health,” and “urinary tract” in the respective drugstores’ online pharmacy. Product name, main ingredient, dose, and directions for use were collected. Unit price range was included as opposed to individual unit price due to price variation related to intermittent sales, consumer use of coupons, and inflation. Evidence based data on intended results, ability to treat UTI, and ability to prevent UTI were included.

Results: Three of the five top US drugstores were included in this review: CVS Pharmacy, Walgreens, and Walmart. From the search, five main categories of ingredients were identified for over-the-counter UTI prevention or relief: phenazopyridine hydrochloride, methenamine / sodium salicylate, cranberry, D-mannose, and a combination of cranberry / D-mannose. While ten and five commercial products were identified for phenazopyridine hydrochloride and methenamine / sodium salicylate, respectively, hundreds of cranberry and D-Mannose supplements were captured in the search results. Therefore, all phenazopyridine hydrochloride and methenamine / sodium salicylate urinary tract health products were reviewed, but only the best-selling cranberry and D-mannose products were included (Table 1). Overall, ingredients, dosing, and directions for use were consistent for phenazopyridine hydrochloride and methenamine / sodium salicylate products. There was greater variety in cranberry and D-mannose products.

Conclusions: Patients are interested in nonantibiotic UTI prevention and relief options but may be overwhelmed with the plethora of over-the-counter products and misleading marketing messages. Proper use of over-the-counter products is dependent on consumer knowledge. While information is available to patients and clinicians, it can be difficult to sort through data and provide practical guidance. The summary table created by this review of over-the-counter products for UTI prevention and relief could be disseminated widely by the American Urogynecologic Society to attempt to meet patients’ needs by promoting vetted consumer materials available for patient use. Additionally, patients can utilize this data to make cost-effective choices when selecting over-the-counter products.

Legend:
*Over-the-counter strengths are too low. Prescription methenamine (1g twice daily) can prevent UTIs.
† Hundreds of cranberry supplements available over-the-counter.
‡ Current evidence demonstrates 36 – 72mg of proanthocyanidins can prevent UTIs, but over-the-counter supplements are unregulated, and product amount is difficult to ascertain.
§ Hundreds of D-Mannose supplements available over-the-counter. Recommended dose is three 500mg tablets 1-3 times daily.
¶ There is little evidence to support or refute using D-mannose to prevent UTIs.