Recurrent UTI in non-pregnant Women ≥ 3 UTIs/year
Antimicrobial prescribing: NHS Forth Valley
2 in 6 months or 3 or more per year
Always assess for underlying causes of recurrent UTI
First line: advise simple measures including hydration; ibuprofen for symptom relief. Cranberry products work for some women.
Second Line: Stand by or post-coital antibiotics.
Third line: antibiotic prophylaxis (risk of pulmonary fibrosis in patient taking long term nitrofurantoin). Consider methenamine (1g BD for 6 months and review) if no renal/hepatic impairment.
Review antibiotic prophylaxis after 3-6 months of use with a view to stopping them as there is no evidence of additional benefit beyond 3-6 months
Drug details
Nitrofurantoin
50–100mg
stat dose (off-label) - Post coital or following exposure to a trigger
Prophylaxis OD at night - must be reviewed at 6 months (only if post-coital/trigger initiated dosing ineffective)
Use 50mg immediate release capsules
(or MR capsules only if above preparation is unavailable)
orTrimethoprim
100mg
Post coital stat (off-label)
Prophylaxis OD atnight review at 6 months