Recurrent urinary tract infection - Revision history

Aidan: /* Prevention */

2025-04-11T17:47:26Z

Prevention

← Older revision		Revision as of 17:47, 11 April 2025
Line 17:		Line 17:
	* Can consider [[methenamine]] 1 g twice daily for 1 year		* Can consider [[methenamine]] 1 g twice daily for 1 year
	** Technically non-inferior to antibiotic prophylaxis, though likely not as effective[[CiteRef::harding2022al]]		** Technically non-inferior to antibiotic prophylaxis, though likely not as effective[[CiteRef::harding2022al]]
	* Limited evidence for vitamin C, oral probiotics, vaginal Lactobacillus capsules, garlic extract, cranberry juice or extract, L-arginine, and D-mannose		* Limited evidence for vitamin C, oral probiotics, vaginal Lactobacillus capsules, garlic extract, cranberry juice or extract[[CiteRef::konesan2022th]], L-arginine, and D-mannose[[CiteRef::konesan2022th]]
	** However, it is probably quite safe to use cranberry extract, D-mannose, and probiotics		** However, it is probably quite safe to use cranberry extract, D-mannose, and probiotics
	** Vaginal Lactobacillus capsules are promising in early studies		** Vaginal Lactobacillus capsules are promising in early studies

Aidan at 17:21, 27 September 2024

2024-09-27T17:21:03Z

← Older revision		Revision as of 17:21, 27 September 2024
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	* Low threshold for vaginal estrogen in post-menopausal women		* Low threshold for vaginal estrogen in post-menopausal women
	* Can consider [[methenamine]] 1 g twice daily for 1 year		* Can consider [[methenamine]] 1 g twice daily for 1 year
			** Technically non-inferior to antibiotic prophylaxis, though likely not as effective[[CiteRef::harding2022al]]
	** Technically non-inferior to antibiotic prophylaxis, though likely not as effective<ref>Harding C, Mossop H, Homer T, Chadwick T, King W, Carnell S, Lecouturier J, Abouhajar A, Vale L, Watson G, Forbes R, Currer S, Pickard R, Eardley I, Pearce I, Thiruchelvam N, Guerrero K, Walton K, Hussain Z, Lazarowicz H, Ali A. Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women: multicentre, open label, randomised, non-inferiority trial. BMJ. 2022 Mar 9;376:e068229. doi: 10.1136/bmj-2021-0068229. PMID: 35264408; PMCID: PMC8905684.</ref>
	* Limited evidence for vitamin C, oral probiotics, vaginal Lactobacillus capsules, garlic extract, cranberry juice or extract, L-arginine, and D-mannose		* Limited evidence for vitamin C, oral probiotics, vaginal Lactobacillus capsules, garlic extract, cranberry juice or extract, L-arginine, and D-mannose
	** However, it is probably quite safe to use cranberry extract, D-mannose, and probiotics		** However, it is probably quite safe to use cranberry extract, D-mannose, and probiotics

Aidan: Created page with "== Background == * At least 2 UTIs (with cultures) in 6 months or 3 in 12 months * Most common in postmenopausal women == Management == * Acute treatment of urinary tract infection for each episode * Assess for red flags that may warrant further assessment, including pelvic mass, vaginal prolapse beyond the hymen, rectal prolapse, nephrolithiasis, chronic catheterization, immunosuppression, atypical symptoms (eg, gross hematuria, pneumaturia following..."

2022-08-01T12:36:24Z

Created page with "== Background == * At least 2 UTIs (with cultures) in 6 months or 3 in 12 months * Most common in postmenopausal women == Management == * Acute treatment of urinary tract infection for each episode * Assess for red flags that may warrant further assessment, including pelvic mass, vaginal prolapse beyond the hymen, rectal prolapse, nephrolithiasis, chronic catheterization, immunosuppression, atypical symptoms (eg, gross hematuria, pneumaturia following..."

New page

== Background ==

* At least 2 UTIs (with cultures) in 6 months or 3 in 12 months
* Most common in postmenopausal women

== Management ==

* Acute treatment of [[urinary tract infection]] for each episode
* Assess for red flags that may warrant further assessment, including pelvic mass, [[vaginal prolapse]] beyond the hymen, [[rectal prolapse]], [[nephrolithiasis]], chronic catheterization, immunosuppression, atypical symptoms (eg, gross hematuria, pneumaturia following surgical procedure), or rapid progression to [[sepsis]]

== Prevention ==

* Drinking 2 to 3 L of water daily
* Postcoital voiding
* Wiping front to back
* Low threshold for vaginal estrogen in post-menopausal women
* Can consider [[methenamine]] 1 g twice daily for 1 year
** Technically non-inferior to antibiotic prophylaxis, though likely not as effective<ref>Harding C, Mossop H, Homer T, Chadwick T, King W, Carnell S, Lecouturier J, Abouhajar A, Vale L, Watson G, Forbes R, Currer S, Pickard R, Eardley I, Pearce I, Thiruchelvam N, Guerrero K, Walton K, Hussain Z, Lazarowicz H, Ali A. Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women: multicentre, open label, randomised, non-inferiority trial. BMJ. 2022 Mar 9;376:e068229. doi: 10.1136/bmj-2021-0068229. PMID: 35264408; PMCID: PMC8905684.</ref>
* Limited evidence for vitamin C, oral probiotics, vaginal Lactobacillus capsules, garlic extract, cranberry juice or extract, L-arginine, and D-mannose
** However, it is probably quite safe to use cranberry extract, D-mannose, and probiotics
** Vaginal Lactobacillus capsules are promising in early studies

=== Considerations for Specific Risk Factors ===
{| class="wikitable"
! colspan="2" |Risk Factor
!Prevention
|-
|Premenopausal woman
|related to sex
|postcoital voiding, avoid anal intercourse, postcoital antibiotic
|-
| rowspan="2" |Postmenopausal woman
|genitourinary atrophy
|vaginal estrogen (Estradiol 10mcg tablet inserted once daily 2 weeks then twice weekly forever)
|-
|related to sex
|postcoital voiding, avoid anal intercourse, postcoital antibiotic
|-
| colspan="2" |Urinary catheterization
|catheter care
|-
| colspan="2" |Poor bladder empyting
|refer to specialist
|-
| colspan="2" |[[Diabetes mellitus]]
|manage glucosuria, assess bladder emptying (especially if neuropathy)
|-
| colspan="2" |Advanced uterine prolapse
|refer to specialist for surgery or pessary
|-
|Enterovesical fistula
|pneumaturia
|consider suppressive antibiotics until resolved
|-
|Nephrolithiasis
|recurrences with same organism
|consider stone removal
|-
|Urethral diverticulum
|postvoid dribbling, dyspareunia, vaginal bulge
|consider suppressive antibiotics until diverticulum surgically corrected
|-
| rowspan="2" |[[Renal transplant]]
|[[pyelonephritis]]
|lower immunosuppression, consider suppressive antibiotic
|-
|[[asymptomatic bacteriuria]]
|treat as infection for first 3 to 12 months
|}

=== Prophylactic Dosing ===

* Reassess after 3 to 6 months after addressing underlying risk factors

{| class="wikitable"
!Antibiotic
!Dosing
|-
|[[nitrofurantoin]]
|50 to 100 mg p.o. once daily
|-
|[[TMP-SMX]]
|0.5 to 1 SS tab p.o. once daily to 3 times weekly
|-
|[[cephalexin]]
|125 to 250 mg p.o. once daily
|-
|[[fosfomycin]]
|3 g p.o. once weekly
|}

== Further Reading ==

* Recurrent Urinary Tract Infections in Adult Women. ''JAMA''. 2020;323(7):658-659. doi: [https://doi.org/10.1001/jama.2019.21377 10.1001/jama.2019.21377]