Recurrent Urinary Tract Infection

Recurrent Urinary Tract Infection

Recurrent Urinary Tract Infection

Recurrent Urinary Tract Infection Definition:

Two separate culture-proven episodes of acute bacterial cystitis and associated symptoms within six months or three episodes within one year.

Recurrent Urinary Tract Infection Risk factors:

Recurrent Urinary Tract Infection Diagnosis:

  • Symptoms:

There is significant symptom overlap between UTI and many other urogynecologic conditions.

  • Dysuria
  • Urination Frequency
  • Urination Urgency
  • Hematuria
  • suprapubic pain
  • flank pain, fever and chills, and nausea and vomiting (possibility of pyelonephritis)
  • Urinary odor
  • changes in urinary appearance

With aging, symptoms may be less clear.

  • Urinalysis:

Testing for hematuria, proteinuria and pyuria.

  • Urine culture

To determine the type of bacteria and the appropriate antibiotics.

  • Imaging and Endoscopy might be done for the following cases:
    • Persistent symptoms
    • Rapid recurrence after appropriate treatment
    • Suspected stone
    • Women with diabetes
    • Post-void Residual


  • Nonsteroidal anti-inflammatory medications are used for symptomatic relief.
  • Antibiotic therapy:
    • Nitrofurantoin: duration is typically between 7 -10 days.
    • Trimethoprim-sulfamethoxazole: duration between 3 – 14 days.
    • Fosfomycin: single dose.
    • Other alternatives: .β-lactams, and fluoroquinolones.

To avoid recurrence:

  • Antibiotic Prophylaxis:
    • Single dose after intercourse, when UTI is related to sexual intercourse.
    • Single dose of antibiotic for a duration ranges from 6 months to 2 years.
  • Estrogen: for women low in estrogen, e.g. postmenopausal women:
    • Vaginal estrogen cream: 0.5 mg daily for 2 weeks, followed by twice weekly for 8 months.
    • Vaginal estrogen ring: for a total of 36 weeks.
  • Methenamine Salt. Example: AZO.
  • Postcoital voiding.
  • Avoid Spermicide or diaphragm contraceptive.

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