Before or alongside long-term antibiotic prophylaxis, several established measures can reduce recurrent urinary infections in women. Vaginal oestrogen reduces recurrences in postmenopausal women. Methenamine hippurate is an option for prophylaxis. Adequate fluid intake is reasonable advice. Post-coital antibiotic prophylaxis suits women whose infections follow intercourse.
Confirm recurrences with culture before labelling someone as having recurrent UTI, and look for structural or functional causes when infections are atypical, occur in men, or fail to respond.
- Offer vaginal oestrogen to postmenopausal women with recurrent UTI.
- Consider methenamine hippurate as a non-antibiotic prophylactic option.
- Confirm recurrences with urine culture.
- Investigate for underlying causes when infections are atypical or frequent despite prevention.
Why it matters
Every prevented infection avoids an antibiotic course and the resistance that follows.
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