SUMMARY:

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

Evaluation

• 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

Asymptomatic Bacteriuria

• If patient is asymptomatic, urine testing should not be performed
• Asymptomatic bacteriuria should not be treated

Antibiotic Treatment

• 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

Prophylaxis

• 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

Follow Up

• Test of cure should not be performed if patient is asymptomatic
• If symptoms persist after treatment with antibiotics, repeat urine cultures should be performed

Learn More – Primary Sources

AUA: Recurrent Uncomplicated Urinary Tract Infections in Women

Related ObG Topics:

Uncomplicated Cystitis: When to Culture, How to Treat and Recommended Prevention Strategies

Can Drinking More Water Prevent Recurrent Urinary Tract Infections?

Do Cranberries Decrease Risk of UTIs?