- Corresponding author at: Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
- •Recurrent urinary tract infections are common in older women. The majority of recurrences are reinfection from extraurinary sources, such as the rectum or vagina.
- •Vaginal estrogens reduce the incidence of urinary tract infections.
- •Probiotics, cranberry extracts and D-mannose reduce the risk of urinary tract infections.
- •Further wide-scale randomized studies are needed to establish the role of estrogen therapy, probiotics and lactobacilli, as well as to identify other methods to reduce the use of antibiotics.
Urinary tract infections (UTIs) are the most common bacterial infections in women, and increase in incidence after the menopause. It is important to uncover underlying abnormalities or modifiable risk factors. Several risk factors for recurrent UTIs have been identified, including the frequency of sexual intercourse, spermicide use and abnormal pelvic anatomy. In postmenopausal women UTIs often accompany the symptoms and signs of the genitourinary syndrome of menopause (GSM). Antimicrobial prophylaxis has been demonstrated to be effective in reducing the risk of recurrent UTIs in women, but this may lead to drug resistance of both the causative microorganisms and the indigenous flora. The increasing prevalence of Escherichia coli (the most prevalent uropathogen) that is resistant to antimicrobial agents has stimulated interest in novel non-antibiotic methods for the prevention of UTIs. Evidence shows that topical estrogens normalize vaginal flora and greatly reduce the risk of UTIs. The use of intravaginal estrogens may be reasonable in postmenopausal women not taking oral estrogens. A number of other strategies have been used to prevent recurrent UTIs: probiotics, cranberry juice and D-mannose have been studied. Oral immunostimulants, vaginal vaccines and bladder instillations with hyaluronic acid and chondroitin sulfate are newer strategies proposed to improve urinary symptoms and quality of life. This review provides an overview of UTIs’ prophylaxis without antibiotics, focusing on a practical clinical approach to women with UTIs.