A new clinical guideline on the diagnosis and treatment of recurrent urinary tract infections (UTIs) in women was released by the American Urological Association (AUA) together with the Canadian Urological Association (CUA), and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU).
The guideline includes 16 recommendations that cover evaluation, testing, treatment, and follow-up of women experiencing recurrent UTI. Specific to treatment and prophylaxis, the expert panel recommends the following:
- First-line therapy (i.e., nitrofurantoin, trimethoprim-sulfamethoxazole [TMP-SMX], fosfomycin) dependent on the local antibiogram should be used for symptomatic UTIs (Strong recommendation; Evidence level: Grade B)
- Treat recurrent UTI patients experiencing acute cystitis episodes with as short a duration of antibiotics as reasonable, generally no longer than 7 days (Moderate Recommendation; Evidence Level: Grade B)
- In patients with recurrent UTIs experiencing acute cystitis episodes associated with urine cultures resistant to oral antibiotics, treatment may include culture-directed parenteral antibiotics for as short a course as reasonable, generally no longer than 7 days (Expert Opinion)
- Antibiotic prophylaxis may be prescribed to decrease the risk of future UTIs in women of all ages previously diagnosed with UTIs (Moderate Recommendation; Evidence Level: Grade B)
- Cranberry prophylaxis may be offered to women with recurrent UTIs (Conditional Recommendation; Evidence Level: Grade C)
- In peri- and post-menopausal women with recurrent UTIs, vaginal estrogen therapy should be recommended to reduce the risk of future UTIs if there is no contraindication to estrogen therapy (Moderate Recommendation; Evidence Level: Grade B)
“Recurrent UTI is a highly prevalent, costly and burdensome condition affecting women of all ages, races and ethnicities,” said Jennifer Anger, MD, MPH chair of the guideline development panel and urologist at Cedars-Sinai in Los Angeles, California. “With more cases reported each year, it is our hope this guideline provides physicians with a roadmap to reduce the number of UTIs in women, enhance patient health outcomes while also actively practicing antibiotic stewardship.”
The full guideline can be accessed here.