Guideline of guidelines: management of recurrenturinary tract infections in women
Key points
- Nine international guidelines on recurrent urinary tract infection (rUTI) in women, from urological and non-urological organisations, were compared after a search in March 2022.
- Definition and evaluation of rUTI and antibiotic prophylaxis strategies were mostly consistent across guidelines.
- Guidelines emphasised obtaining urine cultures and limiting cystoscopy and upper tract imaging in women without risk factors.
- All guidelines supported either continuous or post-coital prophylactic antibiotics; antibiotic-sparing preventive strategies varied most.
- None of the guidelines was tailored to the management of recurrent complicated UTI.
Overview
This 'guideline of guidelines' compares international recommendations on recurrent UTI in women. It finds broad agreement on how rUTI is defined and evaluated and on antibiotic prophylaxis, but variation in symptomatic treatment, self-initiated antibiotics and antibiotic-sparing prevention. This summary is based on the published structured abstract.
Guidelines compared
PubMed, Google Scholar and the official webpages of major urological, gynaecological, infectious diseases and general practice organisations were searched in March 2022. Nine guidelines were included: European Association of Urology, National Institute for Health and Care Excellence (NICE), Society of Obstetricians and Gynaecologists of Canada, American Academy of Family Physicians, Mexican College of Gynaecology and Obstetrics Specialists, Swiss Society of Gynaecology and Obstetrics, Spanish Society of Infectious Diseases and Clinical Microbiology, German Association of Scientific Medical Societies, and the combined American Urological Association/Canadian Urological Association/Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction guideline.
Where the guidelines agree
The definition and evaluation of rUTI and antibiotic prophylaxis strategies were mostly consistent. The guidelines emphasised obtaining urine cultures and limiting cystoscopy and upper tract imaging in women without risk factors. Either continuous or post-coital prophylactic antibiotics were supported by all guidelines.
Where the guidelines differ
Recommendations varied for symptomatic treatment, self-initiated antibiotics and antibiotic-sparing preventive strategies: cranberry, vaginal oestrogen, immunoactive prophylaxis with OM-89, intravesical glycosaminoglycan instillation and phytotherapeutics. The authors note that recent randomised evidence supports the use of methenamine hippurate, and that some conflicting recommendations reflect more recent guidelines that include updated evidence.
Scope and gaps
Most guidelines limited their recommendations to otherwise healthy non-pregnant women with uncomplicated cystitis, and none was tailored to recurrent complicated UTI. The authors suggest that future guidelines include recommendations for complex patient groups, such as recurrent complicated UTI.
Frequently asked questions
Do the guidelines agree on antibiotic prophylaxis for recurrent UTI?
Yes. All nine guidelines supported either continuous or post-coital prophylactic antibiotics.
Where do the recommendations differ most?
Mainly in antibiotic-sparing prevention (cranberry, vaginal oestrogen, OM-89, intravesical glycosaminoglycan instillation, phytotherapeutics), and also in symptomatic treatment and self-initiated antibiotics.
Which women do these guidelines mainly cover?
Mostly otherwise healthy non-pregnant women with uncomplicated cystitis; none of the guidelines addressed recurrent complicated UTI specifically.
Source
Kwok M, McGeorge S, Mayer-Coverdale J, Graves B, Paterson DL, Harris PNA, et al. Guideline of guidelines: management of recurrent urinary tract infections in women. BJU Int 2022;130(Suppl 3):11-22. doi:10.1111/bju.15756. Summary prepared by Medpresso from the published abstract of the original publication; it is not a substitute for the full text or medical advice.