References

  • Abbo LM, Hooton TM. Antimicrobial Stewardship and Urinary Tract Infections. Antibiotics. 2014;3(2):174-92.
  • Alidjanov JF, Naber KG, Abdufattaev UA, et al. Reevaluation of the Acute Cystitis Symptom Score, a Self-Reporting Questionnaire. Part I. Development, Diagnosis and Differential Diagnosis. Antibiotics. 2018;7(1):6.
  • Anger J, Lee U, Ackerman AL, et al. Recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU guideline. J Urol. 2019;202:282-289.
  • Antimicrobial stewardship. APIC website. Available from: https://apic.org/professional-practice/practice-resources/antimicrobial-stewardship/. Last accessed November 2020.
  • Aragón IM, Herrera-Imbroda B, Queipo-Ortuño MI, et al. The Urinary Tract Microbiome in Health and Disease. Eur Urol Focus. 2018;4(1):128-138.
  • Arnold JJ, Hehn LE, Klein DA. Common questions about recurrent urinary tract infections in women. Am Fam Physician. 2016;93(7):560-569.
  • Aydin A, Ahmed K, Zaman I, et al. Recurrent urinary tract infections in women. Int Urogynecol J. 2015. 26(6):795-804.


  • Belyayeva M, Jeong JM. Acute Pyelonephritis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020.
  • Bessler WG, vordem Esche U, Zgaga-Griesz A, et al. Immunostimulatory properties of the bacterial extract OM-89 in vitro and in vivo. Arzneimittelforschung. 2010;60(6):324-329.
  • Bessler WG, Puce K, vordem Esche U, et al. Immunomodulating effects of OM-89, a bacterial extract from Escherichia coli, in murine and human leukocytes. Arzneimittelforschung. 2009;59(11):571-577.
  • BMJ Best Practice. Acute cystitis. Last reviewed: 4. Sept. 2021. Available at: https://bestpractice.bmj.com/topics/en-gb/298. Last accessed October 2021.
  • Bonkat G, Bartoletti R, Bruyére F, et al. EAU Guidelines on Urological Infections. Published 2021. Available from: https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-Urological-infections-2020.pdf. Last accessed October 2021.
  • Brubaker L, Wolfe AJ. The female urinary microbiota, urinary health and common urinary disorders. Ann Transl Med. 2017;5(2):34.
  • Bump R, Norton P. Epidemiology and natural history of pelvic floor dysfunction. Obstet Gynecol North Am. 1998;25(4):723–746.


  • Cai T, Mazzoli S, Mondaini N, et al. The role of asymptomatic bacteriuria in young women with recurrent urinary tract infections: to treat or not to treat? Clin Infect Dis. 2012;55:771-777.
  • Cai T, Koves B, Johansen TE. Asymptomatic bacteriuria, to screen or not to screen - and when to treat? Curr Opin Urol. 2017;27(2):107-111.
  • Cai T, Mazzoli S, Migno S, et al. Development and validation of a nomogram predicting recurrence risk in women with symptomatic urinary tract infection. Int J Urol. 2014;21(9):929-934.
  • Cresci GAM, Izzo K. Chapter 4 - Gut Microbiome, Adult Short Bowel Syndrome, Academic Press, 2019, 45-54.


  • Falagas ME, Kotsantis IK, Vouloumanou EK, et al. Antibiotics versus placebo in the treatment of women with uncomplicated cystitis: a meta-analysis of randomized controlled trials. J Infect. 2009;58(2):91-102.
  • Flores-Mireles AL, Walker JN, Caparon M, et al. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015;13(5):269–84.
  • Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Dis Mon. 2003;49(2):53–70.


  • Geerlings SE, Beerepoot MA, Prins JM. Prevention of recurrent urinary tract infections in women: antimicrobial and nonantimicrobial strategies. Infect Dis Clin North Am. 2014;28(1):135-47.
  • Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103–e120.
  • Haddad J, Ubertazzi E, Cabrera O, et al. Latin American consensus on uncomplicated recurrent urinary tract infection-2018. Int Urogynecol J. 2020;31(1):35‒44
  • Haydon D, Cleaveland S, Taylor L, et al. Identifying reservoirs of infection: a conceptual and practical challenge. Emerg Infect Dis. 2002;8(12):1468–1473.
  • Hiergeist A, Gessner A. Clinical implications of the microbiome in urinary tract diseases. Curr Opin Urol. 2017;27(2):93-98.
  • Huber M, Krauter K, Winkelmann G, et al. Immunostimulation by bacterial components: II. Efficacy studies and meta-analysis of the bacterial extract OM-89. Int J Immunopharmacol. 2000 ;22(12):1103-1111.
  • Huber M, Baier W, Serr A, et al. Immunogenicity of an E. coli extract after oral or intraperitoneal administration: induction of antibodies against pathogenic bacterial strains. Int J Immunopharmacol. 2000;22(1):57-68.


  • Jancel T, Dudas V. Management of uncomplicated urinary tract infections. West J Med. 2002;176:51–55.
  • Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2012;10(10):CD001321.
  • Jung C, Brubaker L. The etiology and management of recurrent urinary tract infections in postmenopausal women. Climacteric. 2019;22(3):242-249.Negus M, Phillips C, Hindley R. Recurrent urinary tract infections: a critical review of the currently available treatment options. Obstet Gynaecol. 2020;22:115-121.


  • Kirjavainen PV, Pautler S, Baroja ML, et al. Abnormal immunological profile and vaginal microbiota in women prone to urinary tract infections. Clin Vaccine Immunol. 2009;16(1):29-36.
  • Kirwin T, Swinney Lowsley O, Menning J. The effects of pyridium in certain urogenital infections. Am. J. Surg. 1943;62(3): 330-335.


  • Luber KM. The definition, prevalence, and risk factors for stress urinary incontinence. Rev Urol. 2004;6(Suppl 3):S3-S9

  • Mamun M, Hassan J, Nazir K, et al. Prevalence and molecular detection of quinolone-resistant E. coli in rectal swab of apparently healthy cattle in Bangladesh. Int J Trop Dis Health. 2017;24(2):1–7.
  • Ma B, Forney L, Ravel J. Vaginal microbiome: rethinking health and disease. Annu Rev Microbiol. 2012;66:371–389.
  • Marchant A, Duchow J, Goldman M. Adhesion molecules in antibacterial defenses: effects of bacterial extracts. Respiration. 1992;59 Suppl 3:24-27


  • Naber KG, Cho YH, Matsumoto T, et al. Immunoactive prophylaxis of recurrent urinary tract infections: a meta-analysis. Int J Antimicrob Agents. 2009;33(2):111-119.
  • Neugent ML, Hulyalkar NV, Nguyen VH, et al. Advances in Understanding the Human Urinary Microbiome and Its Potential Role in Urinary Tract Infection. mBio. 2020;11(2):e00218-20.
  • Nicola R, Menias CO. 2018. Urinary Obstruction, Stone Disease, and Infection. In: Hodler J, Kubik-Huch R, von Schulthess G. (eds) Diseases of the Abdomen and Pelvis 2018-2021. IDKD Springer Series. Springer, Cham.
  • Nicolle LE, Gupta K, Bradley SF, et al. Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2019;68(10):1611–1615.


  • OM Pharma CCDS OM-89, version 1.1, June 2013.


  • Paphitou NI. Antimicrobial resistance: action to combat the rising microbial challenges. Int J Antimicrob Agents. 2013;42 Suppl:S25–8.
  • Perepanova T.S, Kozlov R.S, Rudnov V.A, et al. [Antimicrobial therapy and prevention of infections of the kidneys, urinary tract and male genitals], Federal clinical recomendations, 2020, 110p. Uromedia ISBN 978-5-6042610-1-9.


  • Rees DL, Farhoumand N. Psychiatric aspects of recurrent cystitis in women. Br J Urol. 1977;49(7):651-658
  • Renard J, Ballarini S, Mascarenhas T, et al. Recurrent Lower Urinary Tract Infections Have a Detrimental Effect on Patient Quality of Life: a Prospective, Observational Study. Infect Dis Ther. 2014;4(1):125-135.
  • Rivera AM, Boucher HW. Current concepts in antimicrobial therapy against select gram-positive organisms: methicillin-resistant Staphylococcus aureus, penicillin-resistant pneumococci, and vancomycin-resistant enterococci. Mayo Clin Proc. 2011;86(12):1230–1243.
  • Rosen DA, Hooton TM, Stamm WE, et al. Detection of intracellular bacterial communities in human urinary tract infection. PLoS Med. 2007;4(12):e329.


  • Schmidhammer S, Ramoner R, Höltl L, et al. An Escherichia coli-based oral vaccine against urinary tract infections potently activates human dendritic cells. Urology. 2002;60(3):521-526.
  • Schneeberger C, Holleman F, Geerlings SE. Febrile urinary tract infections: pyelonephritis and urosepsis. Curr Opin Infect Dis. 2016;29(1):80-85.
  • Sewify M, Nair S, Warsame S, et al. Prevalence of Urinary Tract Infection and Antimicrobial Susceptibility among Diabetic Patients with Controlled and Uncontrolled Glycemia in Kuwait. Journal of Diabetes Research. 2016;(2):1-7.
  • Sihra N, Goodman A, Zakri R, et al. Nonantibiotic prevention and management of recurrent urinary tract infection. Nat Rev Urol. 2018;15(12):750–776.
  • Stress incontinence. Merriam-Webster.com Dictionary. Available from: https://www.merriam-webster.com/dictionary/stress%20incontinence. Last accessed November 2020
  • Sullivan A, Edlund C, Nord CE. Effect of antimicrobial agents on the ecological balance of human microflora. Lancet Infect Dis. 2001;1(2):101–114.


  • Tewary K, Narchi H. Recurrent urinary tract infections in children: Preventive interventions other than prophylactic antibiotics. World J Methodol. 2015;5(2):13-9.



  • Van Pham T, Kreis B, Corradin-Betz S, et al. Metabolic and functional stimulation of lymphocytes and macrophages by an Escherichia coli extract (OM-89): in vitro studies. J Biol Response Mod. 1990;9(2):231-240.
  • Vik I, Bollestad M, Grude N, et al. Ibuprofen versus pivmecillinam for uncomplicated urinary tract infection in women–A double-blind, randomized non-inferiority trial. PLoSMed. 2018;15(5):e1002569.


  • World Health Organisation. Antibiotic resistance. Published July 2020. Available from: https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance. Last accessed November 2020.
  • Wagenlehner F, Wullt B, Ballarini S, et al. Social and economic burden of recurrent urinary tract infections and quality of life: a patient web-based study (GESPRIT). Expert Rev Pharmacoecon Outcomes Res. 2018;18(1):107-117.
  • Wagenlehner FM, Abramov-Sommariva D, Höller M, et al. Non-antibiotic herbal therapy (BNO 1045) versus antibiotic therapy (fosfomycin trometamol) for the treatment of acute lower uncomplicated urinary tract infections in women: a double-blind, parallel-group, randomized, multicentre, non-inferiority phase III trial. UrolInt. 2018;101(3):327-336.


  • RECAP = Where a claim is followed by the RECAP, this means that this claim is endorsed by the RECAP board of experts.
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The RECAP board is a panel of international experts in urological infections. The opinions presented within this educational material are those of the RECAP board and not those of OM Pharma. Members of the RECAP board include: Jose Tiran Saucedo (Mexico), Yvette León (Mexico), Gernot Bonkat (Switzerland), Kurt G. Naber (Germany), Florian ME. Wagenlehner (Germany), J C. Nickel (Canada), Flavia Rossi (Brazil), Enrique Ubertazzi (Argentina), Agnaldo L. da Silva Filho (Brazil), Tamara S. Perepanova (Russia), Bela Köves (Hungary) & Tommaso Cai (Italy).

Patient version : MED-HQ-UV-2100071 / HCP version : MED-HQ-UV-2100070
Date of preparation: December 2021