13 Facts: Bacterial Biofilm Treatment For UTI

When you are battling a chronic urinary tract infection, it is easy to imagine that you are trying to kill a number of single-celled organisms floating around, however, what you really need is biofilm treatment for UTI.

Basically, bacteria team-up against you and your treatment strategies have to account for that.

#1: What are bacterial biofilms?

What are bacterial biofilms? In their 2003 Science paper, Anderson et al. reported that  E.coli form pod-like bulges on the bladder surface that protect the Individual bacteria from your immune system and antibiotics.

“When bacteria are under stress—which is the story of their lives—they team up and form this collective called a biofilm. If you look at naturally occurring biofilms, they have very complicated architecture. They are like cities with channels for nutrients to go in and waste to go out.”, according to Andre Levchenko, Ph.D., Johns Hopkins University.

UTI-sufferers are not alone: bacteria form biofilms everywhere in our body: lungs, bladder, stomach, and even artificial implants (such as an artificial joint) or catheters.

Bottom line, biofilms could be formed in any part of a body and could be caused by many types of bacteria and microorganisms.

#2: Bacterial biofilm treatment for UTI: an uphill battle

The worst news is that bacteria growing in a biofilm could become up to 1,000 times more resistant to antibiotics than a single-celled organism.

Think of biofilm as a type of slime that consists of polysaccharide, protein, and DNA.

Bacteria are producing and then hiding under the slime and it protects them from antibiotics and disinfectant chemicals as well as biofilm helps them resist your body’s natural defense system. 

Besides harboring pathogenic bacteria, biofilms are also behaving differently than any given single bacteria using so-called “quorum-sensing-regulated mechanisms”. This allows the bacteria to communicate with each other and adjust their behavior based on the surroundings. Teamwork in action!

#3: Who can get biofilms

Anybody with a chronic UTI most likely already has biofilms.

If you have any type of chronic infections, you could be dealing with bacterial biofilms.

Your chances are even higher if your bladder was operated or you have or ever had a catheter.

#4: Bacterial biofilms are undetectable by regular tests

Quite exciting from a scientific point of view, but pretty disturbing if you are trying to fight an infection is the ability of the bacteria to enter a latent state during harmful (for them) conditions.

The worst thing is that not only this keeps bacteria alive in a long run, but also makes them undetectable for tests, and without obvious symptoms in a patient.

According to new research, members of microbial communities periodically wake up from the state of dormancy and “send out scouts” to test the environment and see if it is the right time for them to start growing again. This ability called “quorum sensing”.

Quorum sensing is a form of bacterial cell-to-cell communication whereby bacteria secrete and detect signaling molecules known as autoinducers

In this scenario, if the “scouts” sense that the environment is now hospitable, they would signal the remaining cells to wake up and start multiplying, which will result in detectable UTI symptoms.

However, if the “scouts” bring back bad news, the colony will lay low until the next opportunity and would be not detectable in dipstick urine analyses.

That’s why diagnosing bacterial biofilms with standardized tests is next to impossible.

Bacterial biofilm treatment for UTI: antibiotics

#5: Traditional thought: antibiotic prevention

It has been always thought that biofilms can be prevented by early aggressive antibiotic therapy.

Others thought that antibiotic suppressive therapy could work for biofilm treatment for UTI, which basically means taking low doses of antibiotics for prolonged periods of time to avoid an active infection. 

#6: Aggressive antibiotic therapy doesn’t work

 In vitro experiments showed that young biofilm could be easily cleared by antibiotic treatment compared to the matured biofilm. Therefore early and aggressive antibiotic treatments are recommended for bacterial biofilm treatment of UTI.

However, it’s difficult to know if you are about to develop the biofilms, and most of the chronic infections are caused by matured biofilms which are usually difficult to eradicate with antibiotic treatment.

In fact, more and more clinical observations and experimental studies indicate that antibiotic treatment alone is in most cases insufficient to eradicate biofilm infections

Moreover, what in some cases thought as an antibiotic-resistant case of UTI, could be in fact an infection caused by bacterial biofilms since biofilms could be up to 1,000 times more resistant to antibiotic treatment than single-celled bacteria.

#7: Low dose antibiotic therapy is not working

Some hope that low-dose antibiotic therapy could prevent UTI from recurring. Others think, that all it could be doing is just delaying the onset of the infection.

For example, when bladder epithelial cells from 23 spinal cord injury patients were examined, they showed the presence of adherent bacterial biofilms in 96% of the cases. At the very same time when the specimens were collected, most of the patients were receiving antimicrobial therapy, primarily trimethoprim-sulfamethoxazole, which didn’t make any difference in terms of the bladder colonization.

As one of the researchers commented on the results of the study: “The large number of bacteria that emerged with highly virulent and potentially multi-drug resistant characteristics, especially Enterococcus faecalis (33% of isolates), was of concern.

These findings raise questions about the proved efficacy and effectiveness of antibiotics against uropathogenic biofilms adherent to tissues.”.

Simply put, the antibiotics seem to be not working when you are treating bacterial biofilms.

#8: Low dose antibiotics are feeding bacteria!

Antibiotic suppressive therapy basically means that you take a low dose of antibiotics making sure that bacteria keep on “sleeping” and don’t crawl out of their biofilm to cause trouble. 

Shockingly, there is a study suggesting that bacterial biofilms actually thrive when given a low dose of antibiotics leading to persistent chronic infections. Researchers from the University of Southern California and the Oak Crest Institute of Science found a link between chronic lung, sinus and ear infections and low doses of antibiotics.

“Once the biofilm forms, it becomes stronger with each treatment of antibiotics,” said Paul Webster, Ph.D., lead author, senior staff scientist at USC and senior faculty at the Oak Crest Institute of Science.

In an experiment, they demonstrated how pathogenic bacteria after forming a biofilm is capable of literally turning low dose of antibiotics into glycogen to fuel their further growth.

“With an introduction of antibiotic produced glycogen, the biofilms have an almost endless food source that was be used once antibiotic exposure has ended”. Wow! Could there be any better reason to consider an alternative option for bacterial biofilm treatment for UTI? 

#9: Removal of foreign bodies such as a catheter to combat biofilms

As discussed earlier, any foreign object becomes a surface where bacteria can build their
“home”. Bacteria are able to stick to metals, plastics, and stones even stronger than to your bladder lining cells.

Any foreign body provides an ideal surface for biofilms to form on. If you have been experiencing chronic UTIs and have a stone, a catheter, or bladder mesh you would want that removed or at least replaced in order to be successful in bacterial biofilm UTI treatment.

A couple important points about changing a catheter from Nature.com:

  1. Change of the infected catheter is not difficult; however, the time to change is important.
  2. It is recommended to change the infected UC after 48 h of adequate and sensitive antibiotic treatment to minimize the bacterial concentration in the bladder and urinary tract; otherwise, the new UC would be colonized quickly by the bacteria to form a new biofilm.

#10: PH-level during antibiotic treatment

It is well known that infection could lead to inflammation, which results in faster metabolism and increased consumption of oxygen. If oxygen supply could not meet the demand, glycolysis will be activated leading to acidosis, and the effects of antibiotics could be affected by pH values.

It has been reported previously that low pH value (pH 5.2) could decrease the effects of β-lactam antibiotics and increase effects of rifamycin SV.

Therefore make sure to alkalize your urine during antibiotic treatment to have a chance in the battle of biofilm treatment for UTI.

#11: Non-antibiotic biofilm treatment for UTI (supplements)

A promising strategy may be the use of enzyme molecules that can dissolve the biofilm matrix as well as quorum-sensing inhibitors that increase biofilm susceptibility to antibiotics. 

Quorum sensing inhibitors

A range of solutions that when applied weaken the ability of bacteria to sense and react to surroundings called quorum sensing inhibitors.

Various small molecules

While there is a range of the small molecules that have been shown to inhibit QS at the various stages, very few have been clinically tested and even fewer are available commercially.

Azithromycin topically has been used to improve bacterial biofilms susceptibility to antibiotics. Some research demonstrated that a combinational therapy of Azithromycin and ciprofloxacin has promising results against biofilm-associated UTIs, especially in catheter-induced infections.

Lactoferrin, an antimicrobial peptide which anti-biofilm efficacy has been demonstrated in various studies and it is considered to be effective against infections of the urinary tract.

Parthenolide (isolated and purified from Chrysanthemum parthenium plant extract) as a natural product showed also an effect of disrupting pre-established biofilms. 

S-adenosyl-methionine (SAM) Naturally occurring brominated furanones produced by algae have been shown to be effective against biofilm formation in a variety of bacteria such as V. cholerae and E. coli.

Baicalein promoted proteolysis of TraR protein in E. coli, strongly suggesting that its biofilm-inhibition properties might be due to QS inhibition

Luteolin, a dietary polyphenolic flavonoid has been confirmed as a potential antimicrobial agent. It significantly decreased the attachment and invasion of E.coli in human bladder epithelial cells via a range of effects on the bacteria including its ability to form biofilms and ability to move around. Therefore, luteolin or luteolin-rich products as a dietary supplement may be beneficial to control the e.coli-related bladder infections.

N-acetylcysteine (NAC): most popular small molecule

N-acetylcysteine (NAC), a derivative of the amino acid l-cysteine, is a potent thiol-containing antioxidant that serves as a precursor of glutathione synthesis. NAC molecules help the immune system by destroying intermolecular or intramolecular disulfide bonds of bacterial proteins.

NAC demonstrated antimicrobial properties against both Gram-positive and Gram-negative bacteria.

Additionally, an antibiofilm activity has been reported, including reduction of bacteria adhesion, reduction of extracellular polysaccharide production and disruption of mature biofilms.

NAC is a known drug widely applied in a number of different clinical conditions:

In general, NAC considered to be extremely safe for most people with little to no side-effects, however, but it’s a good practice to consult with a physician before starting on NAC.

 Also, due to particular effects of NAC, folks with following issues must exercise caution when taking NAC:

  • Asthma patients: N-acetyl cysteine might cause bronchospasm in people with asthma
  • If you are already taking blood thinners or have a bleeding disorder when your blood does not form a clot. N-acetyl cysteine might slow blood clotting and therefore it could increase your risk of bruising and bleeding.
  • If you are going for a surgery, stop taking N-acetylcysteine at least 2 weeks before a scheduled surgery since it might slow blood clotting and this might increase the risk of bleeding during and after surgery.
  • Obviously, do not take NAC if you are allergic to acetylcysteine
  • One study reported that very high doses (up to 40 times higher than a regular therapeutic dose) of NAC caused pulmonary arterial hypertension (PAH) in mice.

In general, NAC is widely used in medicine since early 2000 and so far has been reported as well-tolerated.

While there are many well-documented uses of NAC due to its antimicrobial effects, there is only one UTI-specific study that I was able to find.

This study compared a preventive regimen of two groups: one was using a low dose of antibiotics, while the other group was taking D-Mannose, NAC and Morinda citrifolia fruit extract.

The study showed no significant difference in results between two groups and suggested that non-antibiotic therapy was as effective (and better received with fewer side-effects) as the antibiotic therapy.

Garlic and bacterial biofilms

Many studies have researched effects of garlic on biofilm formation and the results are quite promising, however, we still need to wait for many more successful clinical studies before we can get FDA to agree that garlic could help in our fight against chronic UTIs.

In one study, extract of raw garlic was able to reduce biofilm formation in a lab (in vitro) and disabled bacterial quorum-sensing functions of Pseudomonas aeruginosa (opportunistic bacteria that is responsible for causing persistent and recurrent UTIs among catheterized patients).

The same researchers verified the effects of garlic in a living organism by feeding fresh garlic extract to infected mice. The mice consumed garlic for five days and then their kidneys were evaluated.

Mice that did not receive garlic extract, developed a severe kidney infection, while mice treated with garlic had only mild symptoms with significantly lower renal bacterial counts compared to test group animals.

When bacterial samples from both groups of mice were later evaluated, it was established that the group treated with garlic had significantly less bacterial growth in comparison with the test group who’s biofilms grew more sticky and thick in absence of garlic treatment.

In general, the consensus is that garlic has the prophylactic potential to prevent UTIs caused by biofilm cells of P. aeruginosa in catheterized patients. 

And even if you are taking antibiotics, supplementing with garlic could possibly increase their efficacy.

Other commercial products with possible anti-biofilm effect

#12: How to choose bacterial biofilm treatment supplement?

Frankly, there is no “one size fits all” model, each product has it’s own potential benefits and side-effects.

Moreover, there are no clinical studies with any of the above-mentioned supplements for treatment or prevention of UTI. Therefore, we don’t know if it could be effective and at which dose.

As you can see, all products listed above are considered “supplements”, meaning that they have not been evaluated and recognized by FDA for their beneficial effects, either for their side-effects, and that’s why most of them have very vague labels.

As you might know, it is very expensive to turn something that works into an official FDA approved drug and it is only a viable option if you could patent the drug afterward.

Therefore, there is an obvious problem with most above-mentioned molecules: they are found in nature and have little commercial value for companies that could afford drug trials.

However, for, consumers, this presents another issue: we can only rely on our own experience or reviews of from other patients.

As to myself, I first heard about NAC supplement from a naturopathic doctor who uses it in her practice. I have been using a combo of NAC NOW (once the bottle is over I will switch to NAC Jarrow to try it out since it has pure NAC without other microelements), probiotics & prebiotics preventively for over a year now with no apparent side-effects.

I personally chose NAC for its price and well-documented efficacy but other supplements have plenty of positive reviews as well.

When choosing a supplement, I also wanted to go with something that could benefit my overall health so I do not feel like I’m constantly fighting UTI and, instead, doing good for my whole body.

#13: Anyway, do check with your MD & Amazon

If you decide to start a new supplement, please ask your physician. New side-effects are constantly discovered and it might very well be that a supplement could interfere with other drugs you are taking or could be not advisable given your particular health condition.

Also, do read comments on Amazon. Especially, negative.

While some folks out there could be experiencing side-effects that have nothing to do with the supplement, the wisdom of the crowds is still very valuable. There are plenty of health forums, of course, but I find it beneficial when reviews are directly linked to a particular brand and their product.

But wait, there are good bacteria, too!

I’m (as well as many of you) super concerned about cleanliness. And rightly so, since most UTIs are caused by bacteria that live in our own poop.

But as you might know, there are beneficial bacteria everywhere on our body (including our anus and genitals) as well. Every day good bacteria are helping you to fight the battle with opportunistic bacteria, such as e.coli to keep you healthy.


It’s important that you do not use harsh chemicals in your personal daily hygiene and keep on taking probiotics to re-populate your genitals (yeah, genitals) with good bacteria.

When you take a certain type of probiotic, believe it or not, the freeze-dried bacteria in from the pill come alive and travel all the way through your digestive tract to lower intestines and then ascend into your vagina. This is exactly how vaginal probiotics when taken orally work.



  1. I started d-mannose and interfase plus for an active UTI. I thought it was working and my symptoms were abating but about two days in the symptoms returned strongly and I started getting blood and discharge in my urine. Is this something to be expected?

    • Absolutely not! If you have blood in your urine, this is most likely a UTI. Please do not delay to check in with a doctor. D-Mannose doesn’t work for everybody, unfortunately. And with all biofilm-related supplements, they won’t help with an acute infection on their own, it could be a good idea to take them with antibiotics, but please check with your doctor about it. Best wishes,

  2. Hello Anastasia! Your article has been extremely helpful in educating me on my E.coli infection.! I’ve become more and more educated of this bug over the years but I certainly read things I did not know about. Thank you so much for writing about this, you might be surprised but not even infectious disease doctors explain half of the things I’ve read here…maybe they don’t even know? Or just don’t care… ! Maybe, you can help me or give me some guidance. Here is my story.

    I am a 27 year old woman and I’ve been having asymptomatic E.coli for over 10 years. Doctors keep prescribing me antibiotics to only end up with the urinalysis coming back positive 3-4 days after I stop them. I’ve seen urologists and I do not have any abnormality that might be causing the infection so by now I am sure that my condition is just that the bacteria is extremely difficult to kill. By what I read, I am supposing that I have mature biofilms in my bladder that is why the bacteria resist the antibiotics attack. I was recently prescribed another antibiotic that my infectious disease doctor says that we should try since it is showing that its sensitive and I have not drank it before. I ignored her since I mentioned that at this point it is probably in vain to do this. However, I have been thinking on drinking the mentioned bacterial biofilm treatment supplements and they all seem to sound good to treat my condition and would like to know you perspective in taking them all together with the antibiotics course. I’m not sure this is 100% safe but they are supplements which leads me to believe is fine. I will also take d mannose and try and keep my urine alkaline since I know this helps in the multiplication of the e coli even thought I strongly believe my main issue here is the biofilms especially since I’ve had this infection for so many years. I am not sure but most likely the over use of antibiotics created the resistance and so the biofilms…or can they still be formed for the reason that ive had the infection for such a long time.? If not, I wonder why when I first got treated I they were not successful with the first cycle of antibiotics. ( I must say I had the infection for quite a while before reaching out to a doctor due to not having health insurance.)

    I will highly appreciate if you can guide me since you are more knowledgeable. I give up with doctors already. I wanted to also get pregnant sometime this year but the fact that I have this bacteria, creates a risk of low birth delivery or premature labor which are both very delicate. I want to have a worry-free pregnancy and not have to worry about this but having this in my system makes me terrified to get pregnant yet.
    Also, the fact that the urethra is so close to the vagina opening, apparently the ecoli crawls to it and causes Bacterial vaginosis as well when it interrupts the regular vaginal flora. In other words, I always seem to have vaginal infection because of the ecoli, it is just terrible. ! I have to be douching and coming up with things to control it. Even though I have no symptoms since it is asymptomatic and it is already colonized in the bladder, I’ve always felt uncomfortable having this bacteria in me. It can cause kidneys stones(I don’t have none at the moment, I did have, it was removed, and the bacteria was still there, its never left my body.) and now of course this issue with pregnancy and the non-stop vaginal infection.

    Once again, if you can advice on this I will appreciate it. I was thinking on buying these supplements soon and starting my own made treatment to see if I can get rid of this bug once and for all.

    Thank you in advance Anastasia! =)

    • Hi Diana, thank you for your kind words. As you hypothesized yourself, bacteria could have colonized your vagina as well, I think probiotic supplements could be great to consider. As to biofilm treatment, I’d rather direct you to an integrative medicine professional in your area, I’m not a doctor myself, just a UTI nerd :)) I think you have a better shot at this issue if you talk to somebody who could actually prescribe medications. In fact, the very first doctor who mentioned to me using NAC for UTI was a holistic medicine doctor, and then it took some researching and putting this post together. Which area do you live?

      • Thank you for your response Anastasia. The thing is that, doctors do not seem to find a way around it. That is why I decided to pretty much medicate myself. I live in Miami Florida.

      • Thank you for your response Anastasia. The thing is that, doctors do not seem to find a way around it. That is why I decided to pretty much medicate myself. I live in Miami Florida.

      • Thank you for your response Anastasia. The issue is that doctors do not seem to find a way around it. That is why I decided to pretty much medicate myself. I live in Miami Florida.

  3. Hello Anastasia,
    I recently had a diagnosed severe uti and had to take two rounds of antibiotics to achieve an infection free culture test. However I am experiencing a burning raw irritation that gets worse when sitting. My doctor prescribed phyridium to help the irritation but after 10 days I am still experiencing this raw burning irritation.
    I just started D-Mannose with cranberry and dandelion extract along with cranberry supplements. Then I began researching to find a “preventive” solution and additionally something to do to help with this irritation and found your blog- thank you so very much as your information is exceptional!
    If I may ask your advice for the following:
    * What supplements do you recommend for prevention other than what I am taking (d-mannose and cranberry)?
    *Would you recommend taking garlic supplements?
    *Would you recommend a probiotic with a Prebiotic?
    *Would you have any advise on how to help the existing irritation heal? ( again worse when sitting )
    *What wipes did you recommend?

    I eat activia yogurt everyday.

    Thank you so very much for your time and advise. Again thanks so much for all of this info!

    • Hi Char,
      Here is my personal opinion, I’m not a doctor, so just imagine you are brainstorming with a friend. Here are my thoughts:
      -Drop cranberry and D-Mannose for now, both could cause bladder irritation.
      -Focus on restoring bladder lining, here are some thoughts and supplement ideas in these two posts: bladder supplements guide and herbal guide for UTI . Check with your doctor which natural option (like aloe vera, for example) could substitute or supplement Pyridium
      -Make sure your diet is bladder friendly – no coffee, no fizzy drinks, no wine, no spicy food, more veggies, and berries.
      -Yes, definitely. You can start on probiotics, you need prebiotics if you struggle to add a variety of fiber, otherwise no need to.
      -As to garlic, yes, I’m a big fan and I’d combine it with NAC supplements, too. However, for the first couple months, I would just focus on restoring bladder lining and decreasing inflammation.
      -see above 🙂
      -see my product guide 🙂
      Best of luck! And come to our FB group if you’d like to chat more,

      • Hello Anastasia
        Sorry to bother you again!
        I do have some follow up questions:
        1.*Your opinion- ok to take NAC with probiotics and D-Mannose?
        I am taking your advice and discontinuing the D-Mannose and cranberry until inflammation is gone.
        2.Would taking the garlic supplement, marshmallow tea and ibuprofen be the things to do help to calm the irritation down? I am also using an ice pack.
        3.I am thinking this is bladder inflammation but I only burn mostly when sitting (with a feeling of swollen ness ? Could it be some something else as it seems everyone else has itching. )
        4.I also read using primrose oil lubricant woukd help with the irritation -any opinion on that?
        5. What is your preventive regiment for good flora and urinary health?
        6. What type of wipes would you use?
        Sorry just trying to do the best to get rid of this burning feeling and then be in the road to good health.
        Thanks so much for your help and patience.

        • Hi Char, you should not take any of my advice literally and should consult with your physician before starting or discontinuing any supplements or medications. This website, as well as my thoughts, are for educational purposes only. I’m really not in a position to advise you on a medical treatment or prevention.
          You can check with your doctor, but a clinical study quoted in this post describes a protocol that included D-Mannose and NAC. I don’t think that adding probiotics would affect anything, but again, I’m not a medical professional. You need to be careful with Ibuprofen, you can ask your doctor how much you can take. Normally the dose is pretty significant before it demonstrates an anti-inflammatory action. Please, just check with a clinician.
          We are just speculating here, perhaps you have something completely different. I’d advise talking to a urologist or integrative medicine doctor who could diagnose you properly and try a variety of treatment protocols with you.
          Best wishes,

          • Thank you! Actually feeling better by using lots and lots of water, ibuprofen three times a day, baking soda drink in the afternoon, marshmallow tea, ice pack at night. Will be starting probititcs and D Mannose soon as preventive along with a healthy diet. Thank you again for so much information that helps me to be healthier.

          • I’m happy to hear, dear. Make sure you are watching out for any signs of a flank pain, fever, nausea, weakness, or worsening of UTI symptoms since kidney infection is a known risk when taking ibuprofen. I personally found a heating pack working better for UTI pain, how did you decide to use an ice pack?

  4. Hi,
    I have some questions and would be really grateful for some answers.
    1) Which do you think would be best for e.coli infections – NAC, Lactoferrin or Luteolin?
    2) Are Biofilm Defense and Interfase plus as good as the above three products for e.coli infections?
    3) Is there any chance these products could cause an infection when killing biofilms?

    Thanks for all your info

    • Hi Sam,
      1 & 2) NAC is the most researched option, so I personally opt out for it. I haven’t seen any study that compares any of them together. I use NAC but if I were you, I’d check reviews on Amazon for side-effects (read the negative reviews too)
      3) To my limited understanding, your immune system should be able to take care of it. But I’d combine it with an antibacterial treatment such as D-Mannose, garlic or Uva Ursi, for example. If you are taking an antibiotic, it’s a great time to ask your doc about NAC.

      Best wishes,

      • Hi ,
        Thanks so much. I have a few more questions and would be really grateful if you could provide some answers.

        1) Would this work on e.coli and does it only target bad bacterial biofilms?
        1) Did you try the NAC alongside an antibacterial treatment?
        2) What dose did you take and how i.e. in the morning on an empty stomach?
        3) How do you know that this will reach the bladder? Obviously I don’t want it going to the intestines and disrupting beneficial bacterial biofilms.

        • Hi Sam,
          It’s above my paygrade so to speak to give you my opinion, but here are some links to help you to sort out the situation:
          1&3) Here is a study that looked at taking probiotics and NAC at the same time (for a GI issue though) and demonstrated that good bacteria were able to colonize the GI tract, I guess we can conclude NAC doesn’t hurt them.
          2?) I personally take NAC with garlic and Ibuprofen when I have any slight infection suspicion, for me this combo works, but it could be a placebo effect, who knows 🙂
          I take NAC couple times a week with all my other supplements after breakfast. However, most manufacturers recommend a pill twice a day. I’d suggest consulting a doctor.
          Best wishes 🙂

          • Thanks so so much. Just to be sure, taking NAC and destroying the biofilm, thereby releasing the bacteria into the bladder, would *not* cause an infection? I want to check this before I try it.

            Should I take d-mannose with it to flush away any e.coli that may come out when the biofilm is destroyed ?

            Sorry for all the questions!

          • Sam, the biofilm is releasing bacteria in your bladder all the time. It’s not some sort of saran wrap that keeps bacteria inactive. We can only hope that NAC could help destroying the biofilm and making it easier for your body to combat bacteria.
            In terms of D-Mannose, I personally think that taking D-Mannose is a safe route since it almost has no side-effects, but ask your doc if you have any doubts. Best of luck!

          • Hi Anastasia,
            Regarding your last comment, does this mean that, if you did indeed have biofilms, you would be having infections all the time – even away from triggers? I thought bacteria was only released from these biofilms during triggers, rather than being released ‘all the time’.

            Therefore, if you were not having infections away from triggers, you can assume you do not have biofilms?

            Thank you

          • Hi Sam,
            My personal, non-medical opinion is that if somebody is having UTIs after sex, the vaginal flora is probably misbalanced and the vagina is colonized with pathogenic bacteria. So I’d start by addressing that potential issue. In terms of biofilms, I don’t know what would be the schedule for bacteria to adhere to. What we know is that they regularly “check” the surroundings and “decide” if to start actively multiplying or stay dormant. But how often is “regularly” – my guess is as good as yours. If the trigger is a certain diet, then I’d probably agree that it could contribute to the bacteria entering the growth stage. If the trigger is sex, then vaginal health is the first thing to look at but it does not mean that bacterial biofilms are not present. You can go through all the links in this post and read the research to form your own opinion, but from what I understand, biofilms is a next natural step for bacteria to protect themselves once they were present in the environment long enough.
            Best wishes,

          • Hi Anastasia,
            I’ve been looking for your reply about the Floraphage supplement but I can’t now find it. Thanks for your advice – I got my money back but wanted to know if there’s anything you think I can add:
            1) I have a very good diet, lots of probiotic fibre etc and take a daily 50 billion CFU probiotic from a great UK-based company called Healthspan.
            2) For 15 months, I’ve been taking a women’s probiotic of the most researched strains – L. rhamnosus GR-1 ® and L. reuteri RC-14 from a great company called Optibac.
            3) I’ve ordered Aloe Vera capsules to help with any possible inflammation.
            4) UTIs (5 in 4 years) are only triggered by sex so have been focusing on vaginal health and have ordered what seems to be the best D-mannose available – Waterfall D-mannose – and will take this around triggers. Also have an organic ph balanced lube.
            5) Do you think I therefore really need the NAC?

            Thanks so much for all your advice – you are wonderful !!

          • Hi Sam,

            WOW! You are doing a lot! Good job.
            If you have exact dates of your UTIs and if you chart your period’s cycles, see if your UTIs fall on the week right before periods. This is when estrogen is the lowest and could contribute to a shift in vaginal flora. Addressing vaginal health is always a good idea. You can order a pH test vaginal strip and see if your vaginal pH is healthy, too.
            As to your last question, I know about NAC as much as you do by now, you have plenty of info to decide for yourself 🙂 It’s a supplement at the end of the day, there are plenty alternatives.

          • Hi,
            I’ve just found this on NAC that I thought you may find useful: https://www.iherb.com/r/now-foods-nac-600-mg-250-veggie-caps/694/?p=1
            One reviewer of NOW NAC said: ‘The label doesn’t say this, but you should also take vitamin C at the same time — not only for synergistic effect, but to prevent any possibility of kidney stones from long term use. I’d recommend 500 mg with each capsule taken. Like all amino acids, take on an empty stomach with water (ie. 30 minutes before a meal or 2 hours after).’
            Another reviewer mentioned that the NOW NAC product contains the ‘most bioavailable selenium and molybdenum’ and thus can cause elevated levels of selenium. However, the Jarrow formula doesn’t have selenium. I noticed you said you were going to switch to Jarrow anyway but thought I’d mention this.

  5. Hi Anastasia!

    I write this comment having literally just seen a Canadian urologist in Bermuda. I told him about the Interfase Plus and he said he was unable to find any research on it and suggested not taking it.

    I sent him the research you posted on this article on NAC and he is going to look into it and get back to me soon so I will let you know what he says.

    He did recommend the D-Mannose so I will give that another go in more controlled dosages (last time I took it I was just using a heaping spoon full rather than measuring out) and hope the yeast infections (oral and thrush) do not flare up when I next take antibiotics in conjunction with it. I am going to start an anti-candida (no yeast) diet soon anyway as it was recommended to me by a naturopath named Helen Gardiner (she specializes in UTIs in London and was great when I visited her!) so maybe that will help keep the yeast at bay. For clarity – I never had problems with yeast until I started taking the D-Mannose and only have problems with yeast when on antibiotics and D-Mannose. I have two kinds of D-Mannose, both of which you recommended – the Bulk Supplement brand and the Now brand. I was taking both (keep one at home and one at work) so I will stick with one to test to see if I get yeast with one and not another. Will update you on that as I go!

    Unfortunately, he has prescribed me a low dose antibiotic to take after sex for the next three months. His reasoning was to try and clear my system to give the D-Mannose a chance to start working. When I started the D-Mannose for the first time I was too close to needing an antibiotic because the infection was quite strong. So he said if I can get completely UTI clear and get the D-Mannose in my system, hopefully the D-Mannose will do the trick as a preventative. He said he has had a lot of success with the D-Mannose and UTI patients.

    • Hello there, Amanda!

      Well, let’s see what your doctor says about NACs. Could you, maybe withhold from sex till he is done with the reading? 🙂 So at least if you do take antibiotics, you get a chance to combine them with NAC?
      I forgot to ask you, how do you tolerate garlic? You can ask him if he would allow you to take garlic with NAC as an alternative to antibiotics.
      Let’s see if you get any yeast issues with D-Mannose this time around. I hope it was just a coincidence.
      Looking forward to the updates. Best of luck!

      • Hi Anastasia!

        I just pledged for your wipegel! And have posted it to Facebook and am pressuring my friends and family to pledge too! I hope you reach the goal.

        The doctor hasn’t come back to me about NAC but I will order it so I have it and will try anyway given all the reviews and research you’ve located on it and I’m happy to proceed.

        I decided I am going to not take the antibiotic and abstain from sex for two weeks to let the D-Mannose get in my system. I will place the order for NAC today but won’t be able to start it for a couple weeks (I live in Bermuda and things take a while to ship).

        He gave me another medication which isn’t natural and I wanted to know if you have heard of it. I forget the name of it but will post when I am home with the bottle.

        • Amanda, thank you so much for your support! 🙂 I’m very very grateful. Regardless of how this works out I’ll send you a sample 🙂
          Do you have any allergies or liver/stomach issues that would prevent you from trying raw garlic or garlic pills? Ask your doctor if you could take garlic pills or even raw garlic (this will also help to withhold from sex, I bet)
          If you still have any symptoms right now, ask him if you could take NSAIDs to reduce inflammation as well, then add NAC to the combo once you have them (hopefully doc approves).

          • Hey! That’s very generous of you!

            I realized after I posted my comment that I missed stating a response to your question on garlic. I will definitely give it a go! I eat it all the time anyway. Will try the concentrated pills. And you’re right- it will most definitely help with not having sex ha!

            Also- the name of the medicine the urologist gave me to take in conjunction with D-Mannise is Hiprex 1g tablets (Methenamine hippurate). Have you heard of it/what do you think?

            Unfortunately I go into anaphylactic shock if I take NSAIDs so cant do that for inflammation.

    • Aww, thanks, Amanda for such nice words 🙂
      Yes, I save all product mentions that readers bring up, I think the collective is smarter than any individual. I couldn’t find much on this product though, looks like it is a proprietary enzyme blend but let’s hope it does the job.
      Warm regards,


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