José Emilio Hernández-Sánchez

Recurrent urinary tract infections (rUTIs) are a prevalent public health problem in women, with significant clinical, psychological, and economic consequences. Standard antibiotic prophylaxis, while effective, is limited in the medium term due to the risk of bacterial resistance and potential side effects. This narrative review summarizes the current evidence on the efficacy, safety, and economic impact of Uromune^®—a sublingual bacterial vaccine—as a preventive strategy for rUTIs. A literature search was conducted, focusing on systematic reviews and meta-analyses that evaluated Uromune^® in women and in other specific at-risk populations. Available data show that Uromune^® reduces the frequency of UTI episodes, prolongs recurrence-free intervals, and decreases overall antibiotic use. The vaccine has a favorable safety profile, with predominantly mild adverse effects and a low discontinuation rate. Furthermore, its use has been associated with improved quality of life and a marked reduction in direct and indirect healthcare costs. These findings support Uromune^® as an effective, safe, and potentially cost-effective alternative to conventional antibiotic prophylaxis in the current context of increasing antimicrobial resistance.

To determine the variations in the costs of the prophylaxis of recurrent urinary tract infections (RUTIs) among different prevention protocols, a prospective observational multicenter study on 1614 women receiving RUTI prophylaxis was conducted. The patient groups were as follows: Group A (n = 444): conventional suppressive antibiotic therapy; Group V (n = 732): polyvalent bacterial vaccine; and Group O (n = 438): other adjuvant measures. The variables were age, body mass index, American Society of Anesthesiologists (ASA) physical status classification scale, cost of prophylaxis, duration of the RUTI, number of visits for primary and specialized care, number of UTIs, cost of urinalysis, urine culture, urine cytology, and days of sick leave. The mean age was 57.71 years but was found to be lower in GV. The mean expenditure on UTI prophylaxis and treatment per patient was EUR 4908.07, but this found to be higher in GO. Emergency primary care visits were more frequent in GA. The ordinary scheduled visits to primary care visits were more frequent in GV and GO. The mean successive visits was 2.47 and was shown to be lower in GV. The mean expenditure on successive visits was EUR 341.64 but was found to be lower in GV. The mean number of UTIs was 4.83 at 3 months after finishing prophylaxis and 5.01 at 12 months, and it was observed to be lower in GV. Less frequent VCU usage, older age, more ASA III, more frequent use of urinalyses, urine cultures, ultrasounds, and CT scans were associated with higher costs. In GO, IVU was associated with higher costs. The total expenditure related to RUTIs is associated with older age and the number of RUTIs, a poorer general health status, and the use of urinary tract ultrasounds and CT scans. The use of VCUs instead of ultrasounds and CT scans is cost-effective in the management of RUTIs in older women. Immunoprophylaxis is more cost-effective in reducing the number of visits to the primary care emergency room, the number of successive visits to the Urology Department, the number of intercurrent infections, and the need for urinalyses, urine cultures, CT scans, and ultrasounds in the primary care emergency room.