Approach to uncomplicated recurrent UTIs in women: 10 Key Takeaways

Clinical practice guidelines on the diagnosis and treatment of uncomplicated recurrent urinary tract infections (UTIs) in women were released this year by the American Urological Association (AUA), Canadian Urological Association (CUA), and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) and published online May 1, 2019 in the Journal of Urology. 
 
Here are 10 key takeaways from the guidelines.
 
1.     A complete patient history must be elicited along with pelvic examination in women presenting with recurrent UTIs.
2.     Documentation of positive urine cultures associated with prior symptomatic episodes in order to make a diagnosis of recurrent UTI. Repeat urine test if initial urine specimen is suspect for contamination.
3.     Routine cystoscopy and upper tract imaging should be avoided in the index patient (otherwise healthy adult female with an uncomplicated recurrent UTI).
4.     Urine examination, urine culture and sensitivity should be obtained with each episode of symptomatic acute cystitis before starting treatment.
5.     Do not treat asymptomatic bacteriuria in patients.
6.     Use first-line therapy – nitrofurantoin, trimethoprim-sulfamethoxazole (TMP-SMX), fosfomycin – depending on the local antibiogram for the treatment of symptomatic UTIs.
7.     Antibiotics should be prescribed for a short duration as is reasonable; usually no longer than 7 days.
8.     In patients with recurrent UTIs experiencing acute cystitis episodes associated with urine cultures resistant to oral antibiotics, treat with short-term (no longer than 7 days) culture-directed parenteral antibiotics.
9.     On follow up, post-treatment test of cure urinalysis or urine culture in asymptomatic patients is not to be done. But, if symptoms persist, then repeat urine cultures should be obtained to guide further management.
10.  In peri– and post–menopausal women with recurrent UTIs, vaginal estrogen therapy may be used to reduce the risk of future UTIs if there is no contraindication to estrogen therapy
 
(Source: Anger J, et al. Recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU Guideline. J Urol. 2019 May 1:101097JU0000000000000296)
 





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