Approach to preventing recurrent UTI in nonpregnant adults
The best approach to prevent recurrent urinary tract infection (UTI) should be guided by the patient’s preferences. Nonantibiotic strategies are usually recommended first.
Consider antibiotic prophylaxis for adult females1 who have recurrent UTI (ie 2 or more episodes of symptomatic infection within 6 months, or 3 or more infections within 12 months) despite nonantibiotic strategiesKwok, 2022Zare, 2022. For nonpregnant females with recognisable symptoms, an alternative approach to antibiotic prophylaxis is intermittent patient-initiated antibiotic treatment.
Discuss the potential harms of antibiotic therapy with the patient before prescribing antibiotic prophylaxis for recurrent UTI; adverse effects (eg candidiasis) and the emergence of organisms resistant to the antibiotic used for prophylaxis are commonAhmed, 2017Barber, 2013Dason, 2011Gupta, 2013.
Intermittent postcoital antibiotic prophylaxis may be suitable for females in whom UTI is triggered by sexual intercourse. Continuous antibiotic prophylaxis may be considered for females in whom patient-initiated treatment is unsuitable because of difficulty with early recognition of symptoms.
Prophylaxis for recurrent UTI has been poorly studied in males2. Investigation by a urologist is often warranted for males with recurrent UTI. In some situations, patient-initiated antibiotic treatment or continuous antibiotic prophylaxis may be appropriate – seek expert advice.
Do not give antibiotic prophylaxis to patients with asymptomatic bacteriuria.