Clinical guidelines on urinary tract infection in women were released in May 2019 by the American Urological Association (AUA), Canadian Urological Association (CUA), and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU). The American Urological Association (AUA) has issued its first guideline for the diagnosis and treatment of uncomplicated recurrent urinary tract infections (UTIs), emphasizing the importance of cultures and antibiotic stewardship.
Urinary tract infections
Women are at greater risk of developing a UTI than are men. Infection limited to your bladder can be painful and annoying. However, serious consequences can occur if a UTI spreads to your kidneys. Doctors typically treat urinary tract infections with antibiotics. But you can take steps to reduce your chances of getting a Urinary Tract Infection in the first place.
Women presenting with recurrent lower urinary tract infections (rUTI) should undergo a complete patient history and pelvic examination. A diagnosis of rUTI must base on document positive urine culture results in association with prior symptomatic episodes.
An initial urine specimen that may be contaminate prompt a repeat urine study; collection of a catheterize specimen should be considered. Index patients presenting with rUTI should not routinely; so undergo upper tract imaging and cystoscopy. Before beginning treatment in patients with rUTI, urinalysis, urine culture; also sensitivity be perform for each symptomatic acute cystitis episode.
Select patients with rUTI with acute episodes may be offer patient; so initiate treatment (self-start treatment) while urine culture results are pending. Surveillance urine testing, including urine culture; so not perform in asymptomatic patients with rUTI. Asymptomatic bacteriuria not treat.
Duration of antibiotic therapy
Symptomatic UTIs in women should be treat with first-line therapy (ie, nitrofurantoin, TMP-SMX, fosfomycin) and should depend on local antibiogram. The duration of antibiotic therapy for rUTI in patients; so with acute cystitis episodes should be as short as is reasonable (typically no longer than 7 days).
rUTIs in patients with acute cystitis that has show resistance; so to oral antibiotics on urine culture may treat with culture-direct parenteral antibiotics for as short a course as is reasonable (typically no longer than 7 days). After discussing the risks, benefits, and alternatives, antibiotic prophylaxis may be prescribe to reduce the risk of future UTIs in women of all ages previously diagnose with UTI. Cranberry prophylaxis may be offer to women with rUTI.
Posttreatment urinalysis or urine culture to test for cure should not be perform in asymptomatic patients. UTI symptoms that persist after antimicrobial therapy should prompt repeat urine culture to guide further treatment. Vaginal estrogen therapy with no contraindications be recommend to perimenopausal and postmenopausal women with rUTIs to reduce the risk of future UTI.