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Recurrent urinary tract infections (RUTI) are a common health problem. The only comprehensive synthesis on antibiotic prophylaxis in the last 15 years has been a guideline-embedded meta-analysis.We conducted a systematic review and meta-analysis of RCTs published up to 13 October 2020, evaluating patients ≥ 12 years with either ≥2 episodes of lower UTI within 6 months, or ≥ 3 in the past year. Placebo or antibiotics were allowed as comparators. Study quality was low.In the 11 placebo-controlled trials the risk for developing UTI was 85% lower with prophylaxis in comparison to placebo (RR 0.15, 95% CI 0.08-0.29).In the 9 head-to-head trials efficacy of antibiotic agents appeared similar: The pooled RR indicated no difference between nitrofurantoin and comparators [RR 1.01 (0.74-1.37)], nor trimethoprim (+/- sulfamethoxazole) [RR 1.34 (0.89-2.03)] or norfloxacin and comparators [RR 1.17 (0.43-1.70)].Studies comparing intermittent (post-coital) to continuous strategies revealed intermittent application as equally effective.