Uncomplicated recurrent UTI guideline

Female doctor with lady patient_AS206x137

This guideline was developed by a multidisciplinary expert panel: Rees J et al with the support of a grant from Aspire Pharma Ltd.

Urinary tract infection (UTI) usually results from ascending infection of uropathogenic bacteria via the urethra, and typically results in dysuria, urinary frequency, suprapubic tenderness, urinary urgency, and haematuria. About 150 million people worldwide are believed to experience a UTI every year. Women are significantly more likely to experience a UTI than men, with an annual incidence of 12.6% in women and 3% in men. At least one in three women have one episode of UTI requiring antimicrobial therapy by the age of 24 years, and almost 50% of all women experience one UTI during their lifetime.

Patients, particularly women, can develop recurrent UTI in the form of cystitis (lower UTI) or pyelonephritis (upper UTI), both of which may be due to relapse with the same organism or reinfection with a different strain or species of organism. Recurrent infections become a problem in up to 25–30% of women who experience an initial infection, with 44% of all women, 53% of women older than 55 years, and 36% of younger women experiencing a further infection within 12 months. Furthermore, 2.7% of patients experience a second recurrence. Although recurrent UTI is not usually life‑threatening, the high incidence significantly increases healthcare costs and has a negative impact on patients’ quality of life.

If recurrent UTIs are not treated appropriately, they can occasionally lead to kidney damage and renal failure. Standard treatment in the UK currently consists of lifestyle modifications, antibiotic treatments, and non-antibiotic treatments; however, some patients continue to experience recurrent infections and symptoms that affect their quality of life. Furthermore, antimicrobial resistance is a concern, and treatment with antibiotics can increase the resistance of bacteria that cause UTIs, making antibiotics less effective for future use.

Read this working party guideline to learn about:

  • the definition and symptoms of uncomplicated recurrent UTI
  • behavioural and lifestyle modifications for the prevention of uncomplicated recurrent UTI
  • antibiotic treatment of uncomplicated recurrent UTI, taking into consideration antibiotic stewardship
  • non-antibiotic treatments for uncomplicated recurrent UTI, such as glycosaminoglycan layer replacement therapies, topical oestrogen, and vaccines.


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