In infants and children, the strategy of antibacterial long-term infection prophylaxis is more widely used in the protection against urinary tract infections (UTIs) than for hardly any other indication. Development of resistance, side effects of chemotherapeutic agents and acceptance problems require an intensive search for alternatives in the prophylaxis of UTIs. In this context, substances such as D‑mannose, probiotics and herbal preparations are gaining increasing attention, whereby the effectiveness of which, especially in children, still needs proof through therapy studies. This also applies to approaches to vaccine prevention. However, prophylaxis must not be limited to the prescription of medicines. Equally important are the treatment of bladder dysfunction and constipation as well as the elimination of other predisposing factors. There are alternatives to antibiotic prophylaxis for UTIs. However, in cases with a high risk of recurrence and pyelonephritis, it is still currently the better alternative.