Gag Therapy for Recurrent Urinary Tract Infection Assessing Comparability to International Nitrofurantoin Gold Standard Study (GT RACING)

Inclusion Criteria: Adult female patients (>18 years) who had at least 3 symptomatic UTI's in the previous year with no adequate curable therapeutic options (e.g. bladder stones) At least one UTI's must be confirmed with a positive culture and antibiogram, further UTI's must be confirmed with a urine sediment with positive nitrite or a positive culture. Exclusion Criteria: Male < 18 years Pregnant Already on GAG therapy Already on prophylactic antibiotics Started or stopped cranberry/d-mannose therapy or vaginal estrogenic creme in the last two months Had Gentamicin or other antibiotic instillations in the previous 2 months Allergic to >3 regular used antibiotics in Dutch guidelines (ed. Nitrofurantoin, trimethoprim, Fosfomycin) A urinary fistula Urinary stones Urogenital cancer Bladder Pain Syndrome - Interstitial Cystitis Chronic pelvic pain Had a STD untreated or treated in the previous 2 months A urinary diversion An Indwelling catheter A suprapubic catheter Performing >1/day self-catheterization A residue after voiding (PVR) of >200ml Unable (also legal) to give informed consent Recurrent urosepsis Multiresistant bacteria in previous urine cultures Contra-indications and interactions for Nitrofurantoin: severe kidney disfunction (GFR < 30), lung- or liver problems or neuropathy after previous use of nitrofurantoin, acute porphyria, known G6PD deficiency, use of magnesium trisilicate. Contra-indications and interactions for trimethoprim: severe kidney or liver dysfunction, blood count abnormality, use of vitamin K antagonists, use of folic acid antagonists, use of ace inhibitors Severe lung/respiratory disfunction (reduced lung capacity, lung cancer, fibrosis, COPD) Does not tolerate catheterization