Choosing Wisely:

Avoid presumptive antibiotic treatment of recurrent UTIs in women without first obtaining a urinalysis (culture and sensitivity).

Rationale and Comments: Although women with uncomplicated, infrequent UTIs can be treated empirically based on symptoms, women with recurrent UTIs (≥ 3 UTIs in one year, or ≥ 2 in six months) should have a pretreatment urine specimen to document episodes and guide treatment. The use of vaginal, but not oral, estrogen in postmenopausal women is effective in reducing recurrent cystitis and should be used whenever possible. IDSA guidelines regarding cystitis should dictate treatment, accounting for antimicrobial resistance and potential ecological adverse effects.
Sponsoring Organizations:
  • American Urogynecologic Society
  • Sources:
  • IDSA guideline
  • American Urological Association guidelines
  • ACOG guidelines
  • Disciplines:
  • Urologic
  • Infectious disease
  • References: • Brubaker L, Carberry C, Nardos R, Carter-Brooks C, Lowder JL. American Urogynecologic Society best-practice statement: recurrent urinary tract infection in adult women. Female Pelvic Med Reconstr Surg. 2018;24(5):321-335.
    • Anger J, Lee U, Ackerman AL, et al. Recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU guideline. 2019;202(2):282-289.
    • American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 91: treatment of urinary tract infections in nonpregnant women. Obst Gynecol. 2008;111:785-794.
    • Gupta K, Hooton TM, Naber K, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103-e120.

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