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Non-Antibiotic Prophylaxis for Urinary Tract Infections

Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
Author to whom correspondence should be addressed.
Academic Editors: Lawrence S. Young and Catharina Svanborg
Pathogens 2016, 5(2), 36;
Received: 22 October 2015 / Revised: 22 March 2016 / Accepted: 11 April 2016 / Published: 16 April 2016
(This article belongs to the Special Issue Molecular Aspects of Urinary Tract Infection)
PDF [192 KB, uploaded 16 April 2016]


Increasing antimicrobial resistance has stimulated interest in non-antibiotic prophylaxis of recurrent urinary tract infections (UTIs). Well-known steps in the pathogenesis of UTIs are urogenital colonization and adherence of uropathogens to uroepithelial cell receptors. To prevent colonization in postmenopausal women, vaginal, but not oral, estrogens have been shown to restore the vagina lactobacilli flora, reduce vaginal colonization with Enterobacteriaceae, and reduce the number of UTIs compared to placebo. Different lactobacilli strains show different results in the prevention of recurrent UTIs. Intravaginal suppositories with Lactobacillus crispatus in premenopausal women and oral capsules with Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 in postmenopausal women are promising. Ascorbic acid (vitamin C) cannot be recommended for the prevention of UTIs. Cranberries are thought to contain proanthocyanidins that can inhibit adherence of P-fimbriated E. coli to the uroepithelial cell receptors. Cranberry products decreased UTI recurrences about 30%–40% in premenopausal women with recurrent UTIs, but are less effective than low-dose antimicrobial prophylaxis. However, the optimal dose of cranberry product has still to be determined. Initially OM-89, a vaccine with 18 heat-killed E. coli extracts, seemed promising, but this was not confirmed in a recently randomized trial. View Full-Text
Keywords: urinary tract infections; prevention and control; review; non-antibiotic strategies urinary tract infections; prevention and control; review; non-antibiotic strategies
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

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Beerepoot, M.; Geerlings, S. Non-Antibiotic Prophylaxis for Urinary Tract Infections. Pathogens 2016, 5, 36.

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