Recurrent Urinary Tract Infections: Uro-Vaxom®, a New Alternative

Context: Acute uncomplicated cystitis is generally treated with short-term antibiotic therapy. However, recurrence of lower urinary tract infections (UTIs) is very common, especially in premenopausal women. These recurrent infections considerably affect a patient's quality of life and have a huge financial and economic impact on society. Therefore, prevention of UTI recurrence is highly important. Objective: To provide an overview of the state of the art and the current controversies on the prophylaxis of recurrent UTIs. Evidence acquisition: This manuscript is based on presentations given at a satellite symposium held at the 2nd World Congress on Controversies in Urology (CURy) in Lisbon, Portugal. Data were retrieved from recent review papers, original papers, and abstracts on recurrent UTIs. Evidence synthesis: Currently, antibiotic prophylaxis is recommended as a first-line strategy for the prevention of recurrent UTIs in the European Association of Urology guidelines. However, more and more uropathogens become resistant to certain types of antimicrobials. Hence, alternative prophylactic strategies are gaining importance. Oral administration of immunoactive Escherichia coli (E. coli) fractions (Uro-Vaxom (R)) is one of these methods. Our understanding of its mechanism of action has considerably grown over the past 20 yr. In several double-blind, placebo-controlled studies, oral immunostimulation with E. coli extracts significantly reduced recurrent UTIs compared with placebo. Moreover, this strategy was well tolerated. Two new Uro-Vaxom studies have been initiated to gather more data on the long-term efficacy, the treatment regimen, and the mechanism of action of this immunostimulant and to find broader indications for this therapy. Conclusions: Although scientific and clinical data on oral immunostimulation with E. coli fractions have increased significantly, more studies are needed to provide convincing evidence that this strategy is equally effective as antibiotic prophylaxis for the prevention of recurrent cystitis. (C) 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.