Purpose of Review <p>Recurrent urinary tract infections (rUTIs) are a common and vexing problem for women and clinicians alike. Adherence to clinical guidelines for evaluation and antibiotic management is poor and the need for antibiotic stewardship is paramount. For these reasons, there is a growing interest in nonantibiotic prevention strategies for recurrent urinary tract infections (rUTIs). Our objective is to provide a focused, pragmatic review of the latest evidence.</p> Recent Findings <p>Adherence to current clinical guidelines reduces the misdiagnosis and mis- and overtreatment of rUTIs. A better understanding and clinical recognition of asymptomatic bacteriuria (ASB) will also lead to a reduction in the mistreatment of positive urine cultures in asymptomatic women or those with other conditions that cause UTI-like symptoms. Vaginal estrogen is well tolerated and effective for preventing rUTI in postmenopausal women. Cranberry supplements at sufficient doses and methenamine hippurate are effective in preventing uncomplicated rUTI. D-mannose has evidence to support use, although the evidence is of somewhat variable quality.</p> Summary <p>Adherence to current rUTI clinical guidelines is paramount to minimize mis- and overtreatment of rUTIs and maximize antibiotic stewardship. ASB is a common cause of positive urine cultures in post-menopausal women, often confused for rUTIs, and does not need treatment. There is sufficient evidence to recommend vaginal estrogen, cranberry and methenamine hippurate as first-line rUTI prevention strategies, particularly in postmenopausal women. Prevention strategies can be used in series or in tandem, based on patient preference and tolerance for side effects, to create effective nonantibiotic rUTI prevention strategies.</p>