Urology and nephrology update: recurrent urinary tract infection

Urinary tract infections (UTIs) are common among children and adults, with the greatest prevalence in women. One-half of all women will develop a UTI at some point. Approximately one-third of children with UTIs develop recurrent infections, and because recurrent UTIs have been thought to lead to renal scarring, practice has focused on identifying patients at risk of UTIs and limiting recurrence. It is difficult to determine which children are at risk of renal damage, and the benefits of antibiotics or surgery in preventing recurrent UTIs in children are unclear. Therefore, recent guidelines have taken a less aggressive approach to the prevention of recurrent UTIs in children. Recurrent UTIs also may be an issue for women. Sexual intercourse is a major risk factor, and postcoital prophylactic antibiotic treatment has been shown to be effective. Immediate antibiotic treatment of UTI symptoms also has shown efficacy. Although cranberry supplements or juice may be effective, the benefit of other commonly recommended treatments, such as frequent or postcoital voiding, increased fluid consumption, and avoiding bubble baths, has not been shown.