The management of recurrent urinary tract infection: non-antibiotic bundle treatment

Recurrent urinary tract infections (rUTIs) are a common condition with high morbidity and a negative impact on quality of life. They account for approximately 25% of all antibiotic prescriptions, posing a public health concern in an era of multi-drug resistant organisms (MDRO) surge. Various non-antibiotic management strategies have been trying to curb antimicrobials use, and many of them are individually effective to some degree, but there is no experience testing multimodal interventions. We created a “bundle of care” consisting of behavioural measures, vaginal and oral probiotics, D-mannose, and cranberry, to be followed for six months; we enrolled women with rUTIs over a three-year period to test it. Changes in rUTIs, antibiotic use, chronic symptoms, and quality of life were compared between the six months before and after enrolment. Forty-seven women were included in the study, six of whom were excluded from the final analysis. We observed a 76% reduction in urinary infections (p < 0.001) and a reduction in overall antibiotic exposure of more than 90% (p < 0.001); all chronic symptoms showed a trend towards reduction. Adherence to bundle was high (87.2%). Altogether, 80.5% of women experienced an improvement in their quality of life. In our experience, a bundle treatment protocol is effective in reducing recurrences and antimicrobial use in a cohort of women with rUTIs and results in subjective improvement in chronic symptoms and quality of life. Further research is needed to confirm these results.