Recurrent Urinary Tract Infections

Abstract

One in three women has had at least one urinary tract infection (UTI) treated with antibiotics by the age of 24 years, and half of all women experience a UTI in their lifetime with one in four developing recurrence. Recurrent UTI is defined by two or more symptomatic infections in the past 6 months or three or more symptomatic infections in the past 12 months where each UTI follows a complete resolution of the previous UTI. This review describes the risk factors, diagnosis, work-up and treatment, and prevention of recurrent UTIs. Prevention strategies can be divided into antimicrobial and nonantimicrobial strategies. Nonantimicrobial prevention with behavioral changes, cranberry products, or probiotics did not significantly reduce the occurrence of symptomatic UTIs. Compared with placebo, oral estrogens did not reduce UTIs. However, vaginal estrogens do play a role in prevention of recurrence, particularly in postmenopausal women. There are three main strategies for antibiotic prevention: (1) low-dose daily antimicrobial prophylaxis, (2) postcoital antimicrobial prophylaxis, and (3) patient-initiated antimicrobial treatment. All of these strategies decrease infections during prophylaxis period.The choice of regimen should be based on susceptibilities and antibiotic allergy. This review contains 1 figure, 7 tables and 37 references. Keywords: antimicrobial prophylaxis, continuous antibiotics, CT urography, cystoscopy, postcoital prophylaxis, recurrent UTI, risk factors, self-directed therapy, treatment and diagnosis