Journal List > Korean J Urogenit Tract Infect Inflamm > v.9(1) > 1059937

Park and Cho: Antimicrobial Prophylaxis for Recurrent Urinary Tract Infection

Abstract

Recurrent uncomplicated urinary tract infection (UTI) is a common problem in women, causing considerable morbidity and expense, and is a management burden for clinicians. In management of recurrent UTI, non-antimicrobial approaches to prevention of UTI, such as behavioral modifications should first be tried as a way of minimizing antimicrobial exposure, however, antimicrobial treatment of prophylaxis may be necessary in those who continue to have recurrences. Continuous antimicrobial prophylaxis, postcoital prophylaxis with low dose antimicrobials, and intermittent self-treatment with antimicrobials have all been shown to be effective in prevention of recurrent uncomplicated UTIs. The decision regarding which approach to use for prophylaxis depends on the frequency and pattern of recurrence and the patient's preference to commit to a specific method. The risk of adverse events and the plan for pregnancy should be considered before starting any regimen of antimicrobial prophylaxis. The susceptibility of the organisms causing the previous UTIs and history of the patient's drug allergies should be considered before selection of antimicrobials. Before initiation of any prophylaxis regimen, eradication of a previous UTI should be confirmed by a negative urine culture. Continuous antimicrobial prophylaxis is usually used for long periods, thus likely contributing to the widespread problem of antimicrobial resistance. Postcoital prophylaxis and self-treatment approach result in less antimicrobial use, but should be used in the appropriate settings.

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Table 1.
Antibiotics for women with recurrent urinary tractinfections
Continuous prophylaxis  
 TMP-SMX 40/200 mg, daily
 TMP-SMX 40/200 mg, 3/week
 TMP 100 mg, daily
 Nitrofurantoin 50-100 mg, daily
 Cephalexin 125-250 mg, daily
 Cefaclor 250 mg, daily
 Norfloxacin 200 mg, daily
 Ciprofloxacin 125 mg, daily
Postcoital prophylaxis (single dose)  
 TMP-SMX 40/200 mg
 TMP-SMX 80/400 mg
 Nitrofurantoin 50-100 mg
 Cephalexin 125-250 mg
 Ciprofloxacin 125 mg
 Norfloxacin 200 mg
 Ofloxacin 100 mg
Self-treatment prophylaxis  
 TMP-SMX 160/800 mg, twice daily×3 days
 Ciprofloxacin 250 mg, twice daily×3 days
 Norfloxacin 200 mg, twice daily×3 days

Modified from the article of Epp et al. J Obstet Gynaecol Can 2010;32:1082-101.25

TMP-SMX: trimethoprim-sulfamethoxazol.

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