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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 nal 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 con rm these results.

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.

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