Recurrent UTI in Women
Recurrent UTI is its own problem, with its own guideline — the goals shift from "treat this infection" to "stop the cycle."
The big picture
Recurrent UTI is its own problem, with its own guideline. The goals shift from "treat this infection" to "stop the cycle" — confirm the diagnosis with cultures (not just symptoms), look for any complicating factor, treat each episode with the shortest effective course, and then reduce recurrences with prophylaxis, favouring non-antibiotic options first to spare resistance. The AUA index patient is an otherwise healthy woman with recurrent uncomplicated infection.
The framework: define it → evaluate (culture-confirm, exclude complicating factors) → treat episodes (short course, first-line drugs) → prophylaxis ladder (behavioural/non-antibiotic → vaginal estrogen → low-dose antibiotic).
Mechanism pathway
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Diagnostic algorithm
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Board traps
rUTI = ≥2 in 6 months OR ≥3 in 12 months (culture-proven); mostly reinfection.
Culture-confirm — don't treat on symptoms alone; reflex culture preferred.
Don't over-image the index patient — imaging/cystoscopy/urodynamics only if a complicating factor is suspected.
Treat episodes short (≤7 days) with first-line agents by local antibiogram.
Vaginal estrogen for peri/post-menopausal women — recommended, often forgotten.
Non-antibiotic prophylaxis first (cranberry, methenamine, behaviour); low-dose antibiotic ≤12 months, then reassess.