Recurrent UTIs

Question 1

What should be done for all women with recurrent UTIs presenting with a flare of the symptoms?

Answer 1

Urine C&S

Symptomatic relief with paracetamol (+NSAID if ok to use)

Question 2

If a women with recurrent UTIs has mild symptoms, normal immunity, normal renal tract and normal renal function how should she be treated?

Answer 2

Advised can delay treatment if likelihood of UTI is low and await symptom resolution

Question 3

In women with mod+ symptom severity with recurrent UTIs what treatment should be given?

Answer 3

Trimethroprim 200mg bd for 3 days
OR
Nitrofurantoin 50mg qds or 100mg M/R bd

Question 4

Which women with recurrent UTIs should receive a prolonged course of antibiotics?

Answer 4

Have renal impairment
Have an abnormal urinary tract
Are immunosuppressed

Question 5

When should a woman seek further medical attention with recurrent UTIs?

Answer 5

If she develops fever, loin pain, or does not respond to treatment

Question 6

If the symptoms of a UTI persist in a women with recurrent UTIs, after treatment, what should be done?

Answer 6

adjust medication to suit cultures

if no bacterial growth then consider other cause for symptoms

Question 7

What are the other causes of UTI-like symptoms when no bacterial growth is found?

Answer 7

pyelonephritis 
urethral syndrome/ painful bladder/interstitial cystitis
drug-induced cystitis
Atrophic vaginitis/urethritis
threadworms
Cervicitis/urethritis/vaginitis

Question 8

When is it appropriate to refer a women with recurrent UTIs urgently?

Answer 8

aged >45 and have:
- unexplained visible haemeaturia without UTI
- Visible haematuria that persists or recurs after successful treatment of UTI
Aged >60 and have unexplained non-visible hameaturia and either dysuria or raised WCC

Question 9

When should a woman be referred non-urgently for recurrent UTIs

Answer 9

> 60 with recurrent or persistent UTI

Question 10

When should women be routinely referred for recurrent UTIs

Answer 10

Have a risk factor for an abnormality of the urinary tract
Immunocompromised
Have diabetes
Known urinary tract abnormality that may benefit from surgery
Not responded to preventative treatment

Question 11

What are the risk factors for an abnormality of the urinary tract?

Answer 11

PMH of urinary tract surgery or trauma
PMH of bladder or renal calculi
Obstructive symptoms
Urea-splitting bacteria on culture
Persistent bacteruria despite appropriate antibiotic treatment
PMH of abdo or pelvic malignancy
Symptoms of fistula

Question 12

When should prophylactic drug treatment be considered in women with recurrent UTIs?

Answer 12

When disruption to daily life in inacceptable

Question 13

What treatment should be given prophylactically for recurrent cystitis assoc. with sexual intercourse

Answer 13

trimethroprim 100mg to be taken within 2hours of sex

Question 14

What treatment should be given prophylactically for recurrent cystitis NOT assoc. with sexual intercourse

Answer 14

6-month trial of continuous, low dose antibiotic

Trimethoprim 100mg every night or nitrofurantoin 50-100mg every night