<p>Recurrent urinary tract infections (rUTI) are a&#xa0;prevalent condition in women and are associated with substantial psychosocial stress. In many cases the treatment and prophylaxis is carried out with antibiotics, which is not only accompanied by side effects but also contributes to the development of bacterial resistance. Nevertheless, the long-term efficacy of such treatment is often limited. In recent years the role of the microbiome in the pathogenesis of rUTI has been investigated more intensively. An altered composition of the vaginal or intestinal microbiome appears to promote the persistence of uropathogenic pathogens and to facilitate infections. Novel microbiota-based treatment approaches, such as vaginal administration of probiotics, local estrogen therapy or microbiota transfer including fecal microbiota transfer, can help to restore the equilibrium of the microbiome and to therefore prevent infections. These approaches show promising preliminary results but require further clinical validation. Overall, the need for an individualized, antibiotic-sparing concept for the sustainable treatment of rUTI is emphasized.</p>