Uncomplicated Recurrent UTI Clinical Practice Guidelines (2020)

American Urological Association (AUA), Canadian Urological Association (CUA), Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU)

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

June 01, 2020

The American Urological Association (AUA), in collaboration with the Canadian Urological Association (CUA) and Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU), has issued a guideline for the diagnosis and treatment of uncomplicated recurrent urinary tract infections (UTIs), emphasizing the importance of cultures and antibiotic stewardship.[1]

Evaluation

A complete patient history should be obtained and a pelvic examination performed in women presenting with rUTI.

A diagnosis of rUTI depends on positive urine culture results in the presence of prior symptomatic episodes.

Urine studies should be repeated if contamination of an initial urine specimen is suspected; a catheterized specimen should be considered.

In the index patient presenting with rUTI, cystoscopy and upper urinary tract imaging should not be routinely performed.

Urinalysis, urine culture, and sensitivity should be performed for each symptomatic acute cystitis episode before treatment is initiated for rUTI.

Patient-initiated treatment (self-start treatment) may be offered to select patients with rUTI who have acute episodes while urine culture results are pending.

Asymptomatic Bacteriuria

Surveillance urine testing, including urine culture, should not be performed for asymptomatic rUTI.

Asymptomatic bacteriuria (ASB) should not be treated.

Antibiotic Treatment

First-line therapy for symptomatic UTI in women should depend on the local antibiogram.

rUTI in patients with acute cystitis episodes should be treated with a duration of antibiotic therapy that is as brief as reasonable (generally, ≤7 days).

rUTIs in patients with acute cystitis episodes whose urine cultures show resistance to oral antibiotics may be treated with culture-directed parenteral antibiotics for a course that is as brief as reasonable (generally, ≤7 days).

Antibiotic Prophylaxis

Antibiotic prophylaxis may be prescribed to reduce the risk of future UTIs in women of all ages previously diagnosed with UTIs after the risks, benefits, and alternatives are discussed.

Nonantibiotic Prophylaxis

Cranberry prophylaxis may be offered to women with rUTIs.

Follow-up

Posttreatment urinalysis or urine culture to test for cure should not be performed in asymptomatic patients.

Urine cultures should be repeated to guide management when UTI symptoms persist despite antimicrobial therapy.

Estrogen Therapy

Vaginal estrogen therapy, if not contraindicated, should be recommended to perimenopausal and postmenopausal women with rUTIs to decrease the risk of future UTI.

For more information, please go to Urinary Tract Infection (UTI) and Cystitis (Bladder Infection) in Females.

For more Clinical Practice Guidelines, please go to Guidelines.

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