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 ====== | |||
* '''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">Cranberry prophylaxis | ====== <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"> | #* '''<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. | ||