Britain has launched a landmark clinical trial aimed at addressing the debilitating condition of chronic urinary tract infections (UTIs), establishing new specialist hubs in a bid to finally provide evidence-based treatment for thousands of sufferers.
The EAT-UP trial (Extended Antibiotic Treatment in Chronic UTI Patients), sponsored by University College London (UCL) and led by consultant urogynaecologist Rajvinder Khasriya, is now recruiting participants at hospitals in London, Manchester, and Newcastle. Its core purpose is to test a more intensive treatment protocol against the current standard of care, with the hope of establishing the first official NHS guidelines for chronic, rather than just recurrent, UTIs.
The battle for a definition and effective treatment
Currently, there is no official treatment guideline for chronic UTI from the National Institute for Health and Care Excellence (Nice). Nice creates guidelines using the best available evidence of clinical and cost-effectiveness, and it updates them when new clinical areas are identified or significant new evidence emerges. The EAT-UP trial is designed to generate exactly that evidence, aiming to prove the safety and effectiveness of a specific approach.
For the trial, chronic UTI has been newly defined as patients having persistent symptoms for more than three months and more than 20 white blood cells in a urine sample. Getting this distinct medical definition into a peer-reviewed journal could trigger more research and eventually prompt Nice to develop new guidelines.
The treatment being tested was pioneered by the Lower Urinary Tract Symptoms (LUTS) Service at the Whittington Hospital in north London, one of the only NHS clinics to offer it as it departs from standard Nice guidance for recurrent UTIs. It involves a 12-week course of higher, treatment-dose antibiotics combined with a urinary antiseptic called methenamine hippurate (Hiprex). This will be compared against the current standard of care, which is either a low, prophylactic dose of antibiotics or Hiprex alone.
Why current approaches fall short for chronic sufferers
The trial addresses a critical gap in care. Chronic UTIs, where infection is ongoing without symptom-free periods, are distinct from recurrent infections. For patients, the condition can be debilitating, causing persistent pain and a severe impact on quality of life, work, and relationships. A major barrier to treatment is diagnostic failure. Standard NHS methods—the urine dipstick test used by many GPs and traditional urine cultures—are often inaccurate for chronic UTIs. Bacteria can hide behind protective bladder biofilms, leading to negative test results despite glaring symptoms, leaving patients feeling dismissed and without effective help.
This diagnostic shortfall is compounded by the lack of specialist services. Currently, patients from across the nation must travel to London for support from the Whittington’s LUTS clinic, which recently had to pause referrals from outside five London boroughs after its waitlist grew to 56 weeks. Rajvinder Khasriya, the trial’s lead investigator, stated the aim is to build specialist clinics for chronic UTI across the country, similar to NHS mesh services, so patients no longer face this postcode lottery for care.
The trial itself aims to recruit 192 female participants aged 18 and over. Participants will be randomised to one of the two treatment arms for 12 weeks, with clinic visits every four weeks. Khasriya has emphasised that no patient in the standard care group would be left to suffer if their condition worsened, and all patients will be offered full treatment after the three-month trial period. The primary measure of success will be a reduction in urinary white blood cell counts, a direct indicator of infection.
A future of faster, smarter diagnosis
Beyond treatment, the EAT-UP trial is also championing a new diagnostic method that could transform future care. Instead of relying on traditional culture, the trial uses “fresh urine microscopy.” This involves examining a urine sample under a microscope to count white blood cells, which signify the body’s inflammatory response to infection, offering a quicker and potentially more accurate picture for chronic cases.
Each trial site has installed slide scanners to take photographs of urine samples, which are sent to a lab at University College London for analysis. Rajvinder Khasriya said this could pave the way for a new “bedside test” delivering results within minutes. Looking further ahead, it is hoped artificial intelligence could be used to analyse these images, theoretically allowing the technology to be rolled out to GP surgeries nationwide for faster, more accurate diagnosis of chronic UTI.
The trial is actively seeking participants. Women in the UK aged 18+ who have been living with symptoms for at least three months and meet eligibility criteria are invited to contact the research team via email to express their interest.