AUA & CUA Recurrent UTI (2019): Difference between revisions

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***'''<span style="color:#ff0000">Cranberry</span>'''
***'''<span style="color:#ff0000">Cranberry</span>'''
***'''<span style="color:#ff0000">Vaginal estrogen (if post-menopausal)</span>'''
***'''<span style="color:#ff0000">Vaginal estrogen (if post-menopausal)</span>'''
'''Antibiotics'''
 
====== Antibiotics ======
* '''Acute cystitis'''
* '''Acute cystitis'''
** '''Obtain urinalysis, urine culture and sensitivity with each symptomatic acute cystitis episode prior to initiating treatment in patients with rUTIs'''
** '''Obtain urinalysis, urine culture and sensitivity with each symptomatic acute cystitis episode prior to initiating treatment in patients with rUTIs'''
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*** '''In select patients with rUTIs with symptoms of recurrence, presumptive treatment with antibiotics can be initiated prior to finalization of the culture''' based on prior speciation, susceptibilities, and local antibiogram
*** '''In select patients with rUTIs with symptoms of recurrence, presumptive treatment with antibiotics can be initiated prior to finalization of the culture''' based on prior speciation, susceptibilities, and local antibiogram
** '''Use first-line therapy (See [https://www.auanet.org/guidelines-and-quality/guidelines/recurrent-uti Table 3] (statement 9, no direct link) from Original Guideline) dependent on the local antibiogram for treatment of symptomatic UTIs in women'''
** '''Use first-line therapy (See [https://www.auanet.org/guidelines-and-quality/guidelines/recurrent-uti Table 3] (statement 9, no direct link) from Original Guideline) dependent on the local antibiogram for treatment of symptomatic UTIs in women'''
*** <span style="color:#ff0000">Options (3):</span>
*** <span style="color:#ff0000">'''Options (3):'''</span>
****<span style="color:#ff0000">Fosfomycin 3g PO x 1</span>
****<span style="color:#ff0000">'''Fosfomycin 3g PO x 1'''</span>
****<span style="color:#ff0000">TMP-SMX one tab DS PO BID x 3 days</span>
****<span style="color:#ff0000">'''TMP-SMX one tab DS PO BID x 3 days'''</span>
****<span style="color:#ff0000">Nitrofurantoin 100mg PO BID x 5 days</span>
****<span style="color:#ff0000">'''Nitrofurantoin 100mg PO BID x 5 days'''</span>
***A systematic review found no differences between fluoroquinolones, β-lactams (e.g., penicillins and its derivatives, cephalosporins), nitrofurantoin or TMP-SMX in the efficacy or risk of discontinuation due to adverse events
***A systematic review found no differences between fluoroquinolones, β-lactams (e.g., penicillins and its derivatives, cephalosporins), nitrofurantoin or TMP-SMX in the efficacy or risk of discontinuation due to adverse events
*** TMP-SMX is not recommended for empiric use in areas where local resistance rates > 20%]
*** TMP-SMX is not recommended for empiric use in areas where local resistance rates > 20%]
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*##*** Nitrofurantoin 50-100mg
*##*** Nitrofurantoin 50-100mg
*##*** Cephalexin 250mg
*##*** Cephalexin 250mg
'''<span style="color:#ff0000">Non-antibiotic prophylaxis (2):</span>'''
 
# '''<span style="color:#ff0000">Cranberry prophylaxis can be offered for women with rUTIs.</span>'''
====== <span style="color:#ff0000">Non-antibiotic prophylaxis (2):</span> ======
# '''<span style="color:#ff0000">Cranberry prophylaxis</span>'''
#* MOA: thought to be related to proanthocyanidins present in cranberries and their ability to prevent the adhesion of bacteria to the urothelium
#* MOA: thought to be related to proanthocyanidins present in cranberries and their ability to prevent the adhesion of bacteria to the urothelium
#* Oral juice and tablet formulations are available
#* '''<span style="color:#ff0000">Indications</span>'''
#**'''<span style="color:#ff0000">Can be offered for women with rUTIs</span>'''
#*Oral juice and tablet formulations are available
# '''<span style="color:#ff0000">Vaginal estrogen</span>'''
# '''<span style="color:#ff0000">Vaginal estrogen</span>'''
#* '''<span style="color:#ff0000">In peri-and post-menopausal women with rUTIs, vaginal estrogen therapy is recommended to reduce the risk of future UTIs</span>''' if there is no contraindication to estrogen.
#* '''<span style="color:#ff0000">Indications</span>'''
#** '''Oral or other formulations of systemic estrogen therapy have not been shown to reduce UTI and are associated with different risks and benefits.'''
#**'''<span style="color:#ff0000">Recommended in peri-and post-menopausal women with rUTIs,</span>''' if there is no contraindication to estrogen.
#** Given low systemic absorption, risks generally associated with systemic estrogen (cardiovascular disease, thrombosis, breast cancer) are minimal with vaginal estrogen.
#*** '''Oral or other formulations of systemic estrogen therapy have not been shown to reduce UTI and are associated with different risks and benefits.'''
#*** Given low systemic absorption, risks generally associated with systemic estrogen (cardiovascular disease, thrombosis, breast cancer) are minimal with vaginal estrogen.
#* '''Patients with rUTI and are already on systemic estrogen therapy should still be placed on vaginal estrogen. There is no substantially increased risk of adverse events.'''
#* '''Patients with rUTI and are already on systemic estrogen therapy should still be placed on vaginal estrogen. There is no substantially increased risk of adverse events.'''
#* '''Vaginal estrogen therapy has not been shown to increase risk of cancer recurrence in women undergoing treatment for or with a personal history of breast cancer'''. Therefore, vaginal estrogen therapy should be considered in prevention of UTI women with a personal history of breast cancer in coordination with the patient’s oncologist.
#* '''Vaginal estrogen therapy has not been shown to increase risk of cancer recurrence in women undergoing treatment for or with a personal history of breast cancer'''. Therefore, vaginal estrogen therapy should be considered in prevention of UTI women with a personal history of breast cancer in coordination with the patient’s oncologist.