Abstract
Mostly young but also postmenopausal women are often affected by recurrent urinary
tract infections (rUTIs), defined as three or more symptomatic UTI episodes per year
or two or more UTIs within 6 mo. Approximately 20–30% of women with a UTI have a recurrence.
UTIs are associated with considerable morbidity. Treatable predisposing factors in
uncomplicated rUTI are rare but have to be considered. According to the 2015 European
Association of Urology guidelines, the recommendations for prophylaxis of rUTI are
first, behavioral changes and second, nonantimicrobial measures. Antibiotic prophylaxis
should only be considered if the former recommendations are not sufficiently effective,
to avoid adverse events and the collateral damage of unnecessary long-term antibiotic
use. General behavioral recommendations can lower the recurrence rate by about 30%.
Of the nonantimicrobial measures, immunoprophylaxis and local estriol substitution
are effective to lower the recurrence rate, especially in postmenopausal women. Cranberry
products on the market are widely variable and seem to have too low a proanthocyanidin
content to prevent rUTI effectively. Other promising modalities need to be tested
in further controlled trials to prove their preventive benefit. For long-term antibiotic
prophylaxis, oral fosfomycin, nitrofurantoin, trimethoprim, cotrimoxazole, and oral
cephalosporins (especially during pregnancy) are recommended. Placebo-controlled studies
show a high efficacy of long-term antibiotic prophylaxis, but this strategy does not
appear to modify the natural history of rUTI, and most of the studies were performed
at a time when antibiotic resistance was not an issue.
Patient summary
Women of all ages experience recurrent urinary tract infections (rUTIs) that cause
considerable morbidity. Treatable predisposing factors in uncomplicated rUTI are rare
but have to be considered. Guidelines for the prophylaxis of rUTI episodes recommend
behavioral changes followed by nonantimicrobial measures and only then by antibiotic
prophylaxis to avoid adverse events and the collateral damage of unnecessary long-term
antibiotic use.
Keywords
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