Non-Antibiotic Prophylaxis for Recurrent Urinary Tract Infections

Urinary tract infections (UTI) are one of the most common infections affecting women. In a recent study of college women with their first UTI, 27% experienced at least one culture-confirmed recurrence within the six months following the initial infection and 2.7% had a second recurrence during this time period. Women with recurrent UTI have an increased susceptibility to vaginal colonization with uropathogens due to a greater propensity for them to adhere to their epithelial cells. Risk factors include frequent sexual intercourse, spermicide use, first UTI at an early age, and maternal history of UTI. Effectiveness of continuous or post-coital prophylaxis with low-dose antimicrobials or intermittent self-treatment with antimicrobials in management of recurrent uncomplicated UTIs in women has been demonstrated. However, antibiotics are the main driving force in development of antibiotic resistance and can lead to resistance of not only the causative microorganisms, but also the commensal flora. The increasing prevalence of Escherichia coli isolates (the most prevalent uropathogen) that are resistant to antimicrobial agents has stimulated interest in non-antibiotic methods for prevention of UTIs. We discuss the overall use of non-antibiotic methods for prevention of recurrent UTI, including the use of immunostimulant OM-89, a vaginal vaccine or estrogen, lactobacilli prophylaxis, and cranberry.