Recurrent UTI in non-pregnant Women ≥ 3 UTIs/year

TARGET UTIs - includes patient information leaflets on self-care and prevention

SAPG - Recurrent UTI Guidance and UTI management decision aids 

Recurrent definition: 2 episodes in 6 months or 3 or more episodes per year

First line:

Advise simple measures for all patients;

- Ensure adequate hydration
- Post coital urination
- Personal hygiene measures (give TARGET self-care leaflets - link above)
- ibuprofen or paracetamol for symptom relief
- Cranberry products or D-mannose (if e. coli. UTI) provide symptomatic relief for some women.
- If diabetic ensure good blood glucose control
- Review all medicines to ensure no drugs that increase risk of UTI (e.g. SGLT2i, anticholinergics, benzodiazepines)

Second Line:

Stand by or post-coital antibiotics - see below for options. 

Consider methenamine - 1g BD for 6 months (if no renal/hepatic impairment) then review. If improvement in number of episodes continue and review at 12 months.

Consider topical oestrogens for post menopausal patients - use lowest effective dose and review within 12 months

Third line:

Antibiotic prophylaxis - see below for options. Only give regular prophylaxis if patients continue to have recurrence despite all of the above measures being strictly followed. 

- Risk of pulmonary fibrosis in patient taking long term nitrofurantoin. 

- Rotation of antibiotics to address issues of resistance is NOT recommended

- If patients develop a UTI resistant to the antibiotic currently being taken for prophylaxis do not restart