American Urological Association Guidelines for Recurrent Uncomplicated Urinary Tract Infections in Women
Urinary tract infections (UTIs) are a common condition in women. 60% of women will experience at least one UTI in their lifetime, with a faction of them experiencing recurrent UTIs. Recurrent urinary tract infections are defined by two separate culture proven episodes of symptomatic acute bacterial cystitis within 6 months, or three episodes in one year.
Note: These guidelines do not apply to patients who are pregnant, immunocompromised, those with any abnormalities of the urinary tract, who show signs or symptoms of systemic bacteremia, or those who self-catheterize or have indwelling catheters
Document positive urine cultures in prior episodes to establish diagnosis of recurrent UTI
Perform complete history and physical, including a pelvic examination
If urine specimen is suspected to be contaminated
Repeat urine studies, potentially with a catheterized specimen
Do not routinely obtain cystoscopy and imaging in the workup of recurrent UTI
Perform urinalysis, urine culture, and sensitivity with every symptomatic cystitis episode before starting treatment
Self-start treatment while awaiting culture results
Can be offered to certain patients with acute episodes after a urine culture has been collected
If patient is asymptomatic, urine testing should not be performed
Asymptomatic bacteriuria should not be treated
First line antibiotics: Nitrofurantoin | TMP-SMX | Fosfomycin
Use of fluoroquinolones and cephalosporins have been linked to increased antibiotic resistance
Antibiotics should be chosen based on local resistance
Recurrent UTIs should be treated with as short a duration of antibiotics as possible | Maximum 7 days
If urine culture is resistant to oral antibiotics
Treat with parental antibiotics for as short a course possible | Maximum 7 days
Antibiotic prophylaxis to decrease recurrent of future UTIs
Reasonable after shared decision making with patient
Cranberry prophylaxis can be offered
In peri- and post- menopausal women with recurrent UTIs
Vaginal estrogen therapy can reduce the risk of future UTIs if no contraindications
Test of cure should not be performed if patient is asymptomatic
If symptoms persist after treatment with antibiotics, repeat urine cultures should be performed
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