According to the American Urological Association, the following is recommended for recurrent uncomplicated UTI's in women:
- Clinicians should use first-line therapy (i.e., nitrofurantoin, TMP-SMX, fosfomycin) dependent on the local antibiogram for the treatment of symptomatic UTIs in women.
- Clinicians should treat recurrent UTI patients experiencing acute cystitis episodes with as short a duration of antibiotics as reasonable, generally no longer than seven days.
- In patients with recurrent UTIs experiencing acute cystitis episodes associated with urine cultures resistant to oral antibiotics, clinicians may treat with culture-directed parenteral antibiotics for as short a course as reasonable, generally no longer than seven days. [1]
The Recurrent Urinary Tract Infections in Women: Diagnosis and Management Guidelines in The Family Physician state the following regarding UTI prevention:
- Continuous and postcoital antimicrobial prophylaxis have demonstrated effectiveness in reducing the risk of recurrent UTIs.
- Cranberry products may reduce the incidence of recurrent symptomatic UTIs.
- Use of topical estrogen may reduce the incidence of recurrent UTIs in postmenopausal women.
- The following agents have been listed for continuous prophylaxis: Cephalexin (Keflex) Ciprofloxacin (Cipro), Nitrofurantoin (Macrodantin) , Norfloxacin (Noroxin), Trimethoprim (Proloprim), Trimethoprim/sulfamethoxazole (Bactrim, Septra). [2]
Recommendations for prevention of recurrent UTIs were not specifically stated in the American Diseases Society of America (IDSA) treatment guidelines.
Potential measures and treatments for UTIs include behavioral changes, dietary supplementation (such as Chinese herbal medicines and cranberry products), non-steroidal anti-inflammatories (NSAIDs), probiotics, D-mannose, methenamine hippurate, estrogens, intravesical glycosaminoglycans, immunostimulants, vaccines and inoculation with less-pathogenic bacteria. While potential results are promising, higher-level evidence is required before firm recommendations can be made. [3], [4]