Recurrent Uti

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SOGC CLINICAL PRACTICE GUIDELINE
SOGC CLINICAL PRACTICE GUIDELINE
No. 250, November 2010

Recurrent Urinary Tract Infection
Abstract
This Clinical Practice Guideline has been prepared by the Urogynaecology Committee, reviewed by the Family Physicians Advisory Committee, and approved by the Executive and Council of the Society of Obstetricians and Gynaecologists of Canada. PRINCIPAL AUTHORS Annette Epp, MD, Saskatoon SK Annick Larochelle, MD, St. Lambert QC UROGYNAECOLOGY COMMITTEE Danny Lovatsis, MD (Chair), Toronto ON Jens-Erik Walter, MD (Co-Chair), Westmount QC William Easton, MD, Scarborough ON Annette Epp, MD, Saskatoon SK Scott A. Farrell, MD, Halifax NS Lise Girouard, RN, Winnipeg MB Chander Gupta, MD, Winnipeg MB Marie-Andrée Harvey, MD, Kingston ON Annick Larochelle, MD, St. Lambert QC Magali Robert, MD, Calgary AB Sue Ross, PhD, Calgary AB Joyce Schachter, MD, Ottawa ON Jane A. Schulz, MD, Edmonton AB David Wilkie, MD, Vancouver BC FAMILY PHYSICIANS ADVISORY COMMITTEE William Ehman, MD (Chair), Naniamo BC Sharon Domb, MD, Toronto ON Andrée Gagnon, MD, Blainville QC Owen Hughes, MD, Ottawa ON Jill Konkin, MD, Edmonton AB Joanna Lynch, MD, Winnipeg MB Cindy Marshall, MD, Lower Sackville NS Disclosure statements have been received from all members of the committees. The literature searches and bibliographic support for this guideline were undertaken by Becky Skidmore, Medical Research Analyst, Society of Obstetricians and Gynaecologists of Canada. Objective: To provide an update of the definition, epidemiology, clinical presentation, investigation, treatment, and prevention of recurrent urinary tract infections in women. Options: Continuous antibiotic prophylaxis, post-coital antibiotic prophylaxis, and acute self-treatment are all efficient alternatives to prevent recurrent urinary tract infection. Vaginal estrogen and cranberry juice can also be effective prophylaxis alternatives. Evidence: A search of PubMed and The Cochrane Library for articles published in English identified the most relevant literature. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date restrictions. Values: This update is the consensus of the Sub-Committee on Urogynaecology of the Society of Obstetricians and Gynaecologists of Canada. Recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care (Table 1). Options: Recurrent urinary tract infections need careful investigation and can be efficiently treated and prevented. Different prophylaxis options can be selected according to each patient’s characteristics. Recommendations 1. Urinalysis and midstream urine culture and sensitivity should be performed with the first presentation of symptoms in order to establish a correct diagnosis of recurrent urinary tract infection. (III-L) 2. Patients with persistent hematuria or persistent growth of bacteria aside from Escherichia coli should undergo cystoscopy and imaging of the upper urinary tract. (III-L) 3. Sexually active women suffering from recurrent urinary tract infections and using spermicide should be encouraged to consider an alternative form of contraception. (II-2B) 4. Prophylaxis for recurrent urinary tract infection should not be undertaken until a negative culture 1 to 2 weeks after treatment has confirmed eradication of the urinary tract infection. (III-L) 5. Continuous daily antibiotic prophylaxis using cotrimoxazole, nitrofurantoin, cephalexin, trimethoprim, trimethoprimsulfamethoxazole, or a quinolone during a 6- to 12-month period should be offered to women with ³ 2 urinary tract infections in 6 months or ³ 3 urinary tract infections in 12 months. (I-A) 6. Women with recurrent urinary tract infection associated with sexual intercourse should be offered post-coital prophylaxis as an alternative to continuous therapy in order to minimize cost and side effects. (I-A)

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