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Recurrent urinary tract infection in women

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Updated 2024 EAU guidelines for the diagnosis and management of recurrent urinary tract infection in women.

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of recurrent urinary tract infection in women are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2024), the European Association of Urology (EAU 2024), the American College of Obstetricians and Gynecologists (ACOG 2023), the American Urological Association (AUA/CUA/SUFU 2019), the Society of Obstetricians ...
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Classification and risk stratification

Risk factors: as per SEIMC 2017 guidelines, recognize that the main risk factor for rUTIs in sexually active females is the frequency of sexual intercourse.
B
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Diagnostic investigations

History and physical examination: as per AUA/CUA/SUFU 2019 guidelines, elicit a complete patient history and perform a pelvic examination in patients presenting with rUTIs.
B

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  • Urine tests

  • Urinary tract imaging

Diagnostic procedures

Cystoscopy: as per EAU 2024 guidelines, do not obtain an extensive routine workup including cystoscopy in < 40 years old patients with rUTIs with no risk factors.
D

Medical management

Patient-initiated treatment: as per EAU 2024 guidelines, consider offering self-administered short-term antimicrobial therapy in patients with good compliance.
B

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  • Choice of antibiotics

Specific circumstances

Pregnant patients: as per ACOG 2023 guidelines, insufficient evidence to guide management after a rUTI in pregnancy. Consider initiating antimicrobial urinary suppression for the remainder of the pregnancy after treating a recurrent acute infection, preferably using a lower single daily dose of an antibacterial drug to which the bacterium isolated was susceptible.
I

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  • Patients with asymptomatic bacteriuria

Preventative measures

Hygienic measures: as per SEIMC 2017 guidelines, avoid insisting on implementing hygiene measures in patients failed to prevent rUTIs with hygiene.
D

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  • Fluid intake

  • Spermicide use

  • Antibiotic prophylaxis

  • Vaginal estrogen

  • Cranberry

  • Immunoprophylaxis

  • Intravesical hyaluronic acid

  • D-mannose

  • Probiotics

  • Vitamin C

  • Methenamine hippurate

  • Acupuncture

Follow-up and surveillance

Follow-up: as per AUA/CUA/SUFU 2019 guidelines, do not obtain surveillance urine testing, including urine culture, in asymptomatic patients with rUTIs.
D
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