Recurrent UTI prophylaxis: often long, often unreviewed, rarely adjusted for resistance

Design

Retrospective audit across 18 general practices

Population

256 adults on antibiotic prophylaxis for recurrent UTI, Leicestershire, UK

Primary outcome

Guideline concordance, 6-month review, modification after resistance

Effect

Concordant 73.6%; reviewed by 6 months 58.1%; modified after resistance 22.9%; median duration 2.2 years

This retrospective audit covered 256 adults on antibiotic prophylaxis for recurrent UTI in 18 general practices in Leicestershire, UK, between late 2021 and early 2024. Most were women; the mean age was 67.

Median prophylaxis duration was 2.2 years. 73.6% were on a guideline-concordant regimen, mostly nitrofurantoin or trimethoprim, with frequent deviations in dose, formulation and duration. Only 58.1% had a review within six months of starting. Resistant urine isolates appeared in 24.7% and were associated with more breakthrough infection, yet prophylaxis was changed in only 22.9% of those patients. Lower guideline adherence was associated with greater deprivation.

This is one region's audit, and it measures process rather than outcomes. But the gaps it describes — prophylaxis that runs on without review, and resistance reports that do not change the prescription — are common wherever repeat prescriptions are easy. A planned review date at the start fixes most of it.

• Set a review date, usually within six months, when starting UTI prophylaxis.
• Act on a resistant urine isolate: change or stop the prophylactic agent.
• Check dose and formulation against your local guideline at each review.
• Discuss a trial off prophylaxis at review, along with non-antibiotic measures.
• Search your list for patients on prophylaxis for more than a year without review.

Why it matters

Prophylaxis that runs on unreviewed breeds resistance and breakthrough infection in the same patient.

Don't overread it

This audit describes prescribing gaps in one UK region; it does not show the outcomes of fixing them.

The statistics, in plain English

These are audit proportions measured against guideline standards. The link between resistance and breakthrough infection is an association within this group, not a tested effect of changing therapy.

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