Guidelines for the diagnosis and management of recurrent urinary tract infection in women

• DOI: 10.5489/cuaj.11214
• Publication Date: 2011-10-05T14:26:17Z
• Authors: Shawn Dason; Jeyapandy T. Dason; Anil Kapoor
• Keywords: Dysuria; Nocturia; Guideline; Vaginal discharge; Watchful waiting

Recurrent uncomplicated urinary tract infection (UTI) is a common presentation to urologists and family doctors. Survey data suggest that 1 in 3 women will have had diagnosed treated UTI by age 24 more than half be affected their lifetime.1 In 6-month study of college-aged women, 27% these UTIs were found recur once 3% second time.2

The following topics are reviewed this guideline. We also include summary recommendations (Text box 1).

Text 1. Summary recommendations

Definition recurrent UTI

An one occurs healthy host the absence structural or functional abnormalities tract. may defined as 12 months (Level 4 evidence, Grade C recommendation).

Recurrent occur due bacterial reinfection persistence. Persistence involves same bacteria not being eradicated urine 2 weeks after sensitivity-adjusted treatment. A recurrence with different organism, organism weeks, sterile intervening culture recommendation).

Diagnosis UTI

Clinical diagnosis each episode supported symptoms dysuria, frequency, urgency, hematuria, back pain, self-diagnosis UTI, nocturia, costovertebral tenderness vaginal discharge irritation recommendation).

Complicated causes ruled out on history physical examination (Table 1). Uroflowmetry determining post void residual optional tests post-menopausal exclude complicated recommendation).

Culture sensitivity analysis should performed when symptomatic from treatment confirm guide further recommendation)

Investigation UTI

Cystoscopy imaging routinely necessary all B recommendation).

Women risk factors 2) for cause evaluated cystoscopy imaging. Women suspected having without knowledge specific abnormality 1) receive CT urogram abdominopelvic ultrasound +/− abdominal x-ray. imaged consultation radiologist 2011 ACR guidelines Recommendation).

Indications specialist referral

Specialist referral recommended investigation 2), surgical correction 1), uncertain Recommendation).

Prophylactic measures against UTI

Conservative including limiting spermicide use postcoital voiding lack evidence efficacy but unlikely harmful recommendation).

Cranberry products conflicting D recommendation).

Continuous antibiotic prophylaxis 3) effective at preventing UTI. recommendation).

Postcoital within hours coitus recommendation).

Self-start therapy 3-day dose onset another safe option recommendation).

Vaginal estrogen creams rings reduce clinical relative placebo no postmenopausal recommendation).

Due comparative decision begin therapy, choice duration based patient preference, allergies, local resistance patterns, prior susceptibility, cost side effects recommendation).

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UTI: infection; ACR: American College Radiology.