Management of Recurrent UTI

Conservative Management

• Encourage better hydration to ensure more frequent urination.
• Encourage urge-initiated voiding and post-coital voiding.
• Advise sexually active women that diaphragm and spermicide use are risk factors for cystitis and discussalternative contraception.
• There is conflicting evidence to support the use of cranberry products to reduce recurrence, however,patients may choose to obtain and try cranberry products, e.g., high strength cranberry extract capsules may be more effective & acceptable than juice (cranberries should be avoided in patients taking warfarin)(and avoided if history of kidney stones)
• For post-menopausal women with risk factors such as atrophic vaginitis consider prescribing intravaginal or oral oestrogens
• For post-menopausal women with no obvious risk factors, consider referral to urology for further investigations, particularly if recurrent UTI is a recent problem.

Prophylactic Antibiotic

References:

Antibiotic Management of Recurrent Urinary Tract Infections in Adults. cumbria.necsu.nhs.uk