title: [Prophylaxis of recurrent urinary tract infections].
abstract: BACKGROUND
  Recurrent urinary tract infections (rUTI), defined as ≥ 3 UTIs per year, mostly affect young and postmenopausal women. Treatable predisposing factors are rare.
  
  
  METHODS
  General recommendations to reduce rUTIs lower the recurrence rate by up to approximately two thirds. Continuous long-term prophylaxis (LP) with low dose antibiotics or single postcoital doses can reduce the recurrence rate of rUTIs to as low as 5%. According to the European Association of Urology guidelines nitrofurantoin, trimethoprim and co-trimoxazole are the first-line drugs and cephalosporins or fluoroquinolones should be restricted to specific indications. Oral and parenteral immunotherapy were found to be effective in several controlled studies for prevention of rUTIs and can be combined with acute antibiotic therapy.
  
  
  CONCLUSIONS
  Vaginal prophylaxis with estriol has proven its positive effect without serious gynecological side effects and there is also increasing evidence that cranberries prevent rUTIs but the exact mode of this therapy remains to be defined. There are also other promising modalities, such as phytotherapeutics, mannose, urine acidification, influencing bacterial intestinal and vaginal flora and the general immune response by e.g. acupuncture and inpatient rehabilitation, the therapeutic value of which still has to be proven.
authors.affiliation: Fachklinik Urologie, Kurpark-Klinik, Kurstraße 41-45, 61231, Bad Nauheim, Deutschland, drvahlensieck@kurpark-klinik.com.
authors.forename: W
authors.initials: W
authors.lastname: Vahlensieck
authors.forename: H-W
authors.initials: HW
authors.lastname: Bauer
authors.forename: H J
authors.initials: HJ
authors.lastname: Piechota
authors.forename: M
authors.initials: M
authors.lastname: Ludwig
authors.forename: F
authors.initials: F
authors.lastname: Wagenlehner
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000188:drug therapy / Q000517:prevention & control*; D005060:Europe; D005260:Female; D006801:Humans; D017410:Practice Guidelines as Topic; D012008:Recurrence; D040242:Risk Reduction Behavior; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000517:prevention & control*; D014572:Urology / Q000592:standards*
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents