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Introduction: Antibiotic overuse is a significant driver of bacterial resistance. Urinary tract infections (UTIs, cystitis) are the most common condition for which antibiotics are prescribed in the ambulatory setting. Many complementary and integrative approaches to cystitis have been proposed, including probiotics, D-mannose, and several herbal therapies. Trials comparing such therapies with placebo or antibiotics showed mixed, but promising, results. Naturopathy is a system of medicine that has potential to avoid antibiotic use for UTI because of its affinity for nonpharmacologic therapies and its theory that infection is a result of both the immune system's vulnerability and the pathogen's virulence. Methods: The authors conducted a retrospective chart review of cases treated at four naturopathic clinics in the Portland, OR, metro area, where naturopathic doctors (NDs) have a scope of practice consistent with their license as primary care providers. The primary aim was to characterize how NDs treat UTIs in a real-world setting. Secondary aims were to gather preliminary evidence on the types of patient cases receiving such treatments, outcomes of treatments, and associations between presentation and treatment prescriptions. Results: The authors found 82 distinct treatment regimens among 103 individual patients diagnosed with UTI. Most patients received a combination of herbal medicine and behavioral modification (e.g., increase fluid intake), whereas the most common monotherapeutic regimen was antibiotics. Of the 43 patients who were followed up, 15 had no success with nonpharmacologic therapies and required antibiotics. The sample was comparable with national data regarding composition of public versus private insurance, acute versus recurrent/chronic UTI, and percent of cases related to uropathogenic Escherichia coli. Conclusions: NDs practicing in a primary care context frequently prescribe antibiotic and nonantibiotic multimodal therapy for uncomplicated UTI. These results may guide future studies testing complementary and integrative therapies for uncomplicated UTI.

Introduction Pertussis is a vaccine-preventable disease that has made a global resurgence in the 21st century. Vaccine hesitancy remains a persistent barrier to achieving protective vaccination rates. Vaccine-hesitant individuals may be more likely to seek counsel with a naturopathic doctor. Seven more state legislatures have voted to license and/or regulate naturopathic doctors in the last decade, illustrating the growing popularity of naturopathic medicine in the present health care landscape. Still, the growth of naturopathic medicine, and its potential relationship to vaccine hesitancy, is worrisome. Naturopathic doctors can be advocates for immunization to vaccine-hesitant individuals, but ambivalence toward vaccines within the profession remains a public health concern. Case presentation We report cases of pertussis in a family treated in a naturopathic primary care clinic, where naturopathic doctors served as vaccine advocates to a vaccine-hesitant family. Discussion Continued collaboration with public health programs and conventional clinicians is necessary to improve medical science training and vaccine advocacy in the field of naturopathic medicine.