Antimicrobial prophylaxis in women with recurrent urinary tract infections

Recurrent urinary tract infections (UTIs) in women are common, result in considerable morbidity and expense, and can be a management problem for clinicians. Behavioural changes can be useful antimicrobial-sparing measures in the prevention of recurrent UTIs, but antimicrobial prophylaxis may be necessary in those who continue to have recurrences. Continuous prophylaxis, post-coital prophylaxis and intermittent self-treatment with antimicrobials have all been demonstrated to be effective in the prevention of recurrent uncomplicated UTIs. The decision as to which approach to use depends upon the frequency and pattern of recurrences and willingness of the patient to commit to a specific regimen. The risk of adverse events, including antimicrobial resistance, patient's lifestyle and compliance and plans for a pregnancy also need to be considered. The choice of antimicrobial should be based upon the susceptibility pattern of the organisms causing the patient's previous UTIs and history of drug allergies.