Primary Care Provider Practice Patterns in the Management of Recurrent UTI

Understanding the current practice patterns regarding recurrent urinary tract infection (rUTI) can help providers better manage this burdensome condition.

The objective was to describe and compare preferences in the management of acute UTI and rUTI in women among primary care providers, and to determine whether various national practice guidelines are being followed.

Physicians and advanced practice providers in family medicine, general internal medicine, general obstetrics and gynecology, and geriatric medicine at a state-wide academic institution and a community health system were invited to complete an online survey that included questions about management of a postmenopausal patient with rUTI. Comparisons were made between demographic groups, including gender, specialty, practice years, patients with rUTI per month, and practice setting.

A total of 50 surveys were completed. Most respondents (78%) followed guidelines when choosing an antibiotic for empiric treatment of UTI. Notably, 28% would recommend long-term antibiotic prophylaxis for an uncomplicated patient with rUTI. While a majority (62%) would consider vaginal estrogen as their first option for UTI prophylaxis, few providers would also consider other evidence-based nonantibiotic options such as methenamine hippurate (26%) or D -mannose (17%). Primary care providers with "focused" training in menopause care were more comfortable prescribing vaginal estrogen in various clinical scenarios. Providers who saw 6+ patients with rUTI per month were more likely to prescribe methenamine hippurate.

While those surveyed generally followed standard practice in the management of UTI in postmenopausal women, our study identified opportunities for improvement. These include prioritizing nonantibiotic prophylaxis and first-line treatments for acute UTI.