{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T16:46:22Z","timestamp":1782405982668,"version":"3.54.5"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:p>Recurrent urinary tract infections in children represent a common clinical challenge associated with repeated antibiotic exposure and rising antimicrobial resistance. These limitations have intensified interest in non-antibiotic preventive strategies, particularly nutritional bioactives capable of modulating host\u2013microbe interactions. This review provides a clinically oriented synthesis of current evidence on dietary and nutraceutical interventions for the prevention of recurrent pediatric urinary tract infections. Particular attention is given to the limited availability of high-quality pediatric-specific evidence and the heterogeneity of current clinical data. It focuses on cranberry-derived type A proanthocyanidins, probiotics, selected micronutrients and D-mannose. Key mechanistic pathways are also highlighted, including inhibition of uropathogen adhesion, microbiome-mediated biotransformation of bioactives into anti-inflammatory metabolites, and modulation of host immune and epithelial responses within the gut\u2013bladder axis. Available evidence suggests that cranberry products standardized to deliver approximately 36\u202fmg\/day of type A proanthocyanidins may reduce recurrence risk, whereas probiotics and vitamins A, C, and D may provide adjunctive benefits through microbiome modulation and enhancement of innate immune responses. However, substantial heterogeneity in study design, variability in formulations and dosing, and the limited availability of high-quality pediatric randomized trials remain important limitations. Building on current evidence, we propose a pragmatic multimodal framework for non-antibiotic prevention in children that integrates nutritional strategies with clinical risk stratification and individualized care, with particular attention to bioavailability, dose standardization and pediatric-specific factors such as age-related microbiome maturation. Future research should prioritize biomarker-driven endpoints, microbiome-informed stratification and adequately powered pediatric studies to define responders and optimize personalized prevention strategies.<\/jats:p>","DOI":"10.3389\/fnut.2026.1855301","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T15:16:41Z","timestamp":1781104601000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Nutritional bioactives for preventing recurrent urinary tract infections in children: microbiome-mediated mechanisms and clinical implications"],"prefix":"10.3389","volume":"13","author":[{"given":"John","family":"Dotis","sequence":"first","affiliation":[{"name":"Third Department of Pediatrics, Hippokration Hospital, Aristotle University of Thessaloniki","place":["Thessaloniki, 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