Recurrent UTIs

NB: Excludes pregnant patients

• Definition
  • 2 or more separate UTIs in 6 months
  • 3 or more separate UTIs in 12 months
  • (Recurrence of a UTI within 2 weeks is a relapse and indicates treatment failure)

Clinical management

• Urine
  • Dipstick, MSU
• Bloods
  • FBC, U+Es, TFTs, HbA1c
• USS KUB pre and post micturition
  • If abnormal -> refer to urology
  • If normal -> see below

• If normal investigations
  • Step 1
    • Patient information leaflet – https://patient.info/womens-health/lower-urinary-tract-symptoms-in-women-luts
    • Lifestyle advice – reduce caffeine, vaginal lubricants, weight loss, stop smoking
  • Step 2
    • Consider prophylactic antibiotic
      • Nitrofurantoin 100mg MR nocte – beware pulmonary reactions
      • Ciprofloxacin 500mg OD
      • Trimethorim 100mg nocte
    • Methenamine hippurate 1g BD
    • Consider post-coital antibiotics
      • Nitrofurantoin 100mg stat
      • Ciprofloxacin 500mg stat
      • Trimethoprim 100mg stat
  • Step 3
    • If no response after 3-6 months, refer to urology

Reference
https://gps.camdenccg.nhs.uk/cdn/serve/pathway-downloads/1521624654-8acbe171433db4da0c35c6a31a83f930.pdf