Effective risk reduction strategies and pharmacological treatment for uncomplicated recurrent urinary tract infections

INTRODUCTION: Recurrent urinary tract infections (rUTIs) remain a significant clinical challenge, particularly in women, due to limited treatment options and increasing antimicrobial resistance (AMR). AREAS COVERED: This narrative review summarizes nonantibiotic and alternative management strategies to reduce recurrence and antibiotic exposure. Nonantibiotic options such as cranberry products, D-mannose, methenamine hippurate, probiotics, and vaginal estrogen demonstrate varying efficacy, though evidence remains mixed. Immunoprophylactic approaches, including sublingual and oral vaccines (e.g. MV140, OM-89), show promise in reducing infection rates among high-risk patients. Intravesical therapies - both antibiotic and nonantibiotic - offer localized treatment with favorable safety and reduced systemic resistance risk. Conventional antibiotic strategies, including continuous, postcoital, or self-start prophylaxis, remain widely used but require cautious monitoring due to AMR and adverse effects. EXPERT OPINION: Multidisciplinary management, including consultation with infectious disease and allergy specialists, is essential for complex, refractory infections. In rare, severe cases unresponsive to other therapies, cystectomy may be considered. Ultimately, individualized treatment based on risk factors, microbiological patterns, and tolerance is critical to improving outcomes and quality of life in women with rUTIs.