Abstract
Recurrent urinary tract infections (rUTIs) are a growing global public health problem that has a significant impact on patient morbidity, quality of life, and economic burden. This is compounded by excessive antibiotic use in rUTI prophylaxis, prompting consideration of non-antibiotic prophylactic approaches. There has been increasing understanding of the pathophysiology of rUTIs, where bacteria subvert the host immune response and evade therapeutic strategies. Immuno-prophylaxis with monovalent and polyvalent bacterial preparations to elicit an immune response have come into the spotlight. Increasing understanding of how they achieve this based on innovative mechanistic in vitro and in vivo studies has highlighted the role of enhancing the helper T cell type 1 and diminishing the type 2 response. MV140 (Inmunotek SL, Madrid, Spain) is a quadrivalent bacterial preparation which has contemporary evidence to show good efficacy in improving rUTI clinical parameters, which is acceptable to patients, associated with improvements in quality of life, as well as reduced healthcare resource usage and costs. Importantly, it also appears to be safe and is associated with improved rationalization of antibiotic use. Whilst more rigorous studies are awaited, it shows promise in tackling heterogenous clinical entity.