Prevent recurring urinary tract infections (UTIs)

I have helped scores of women with frequent, recurring urinary tract infections (UTIs) over the years.

First, involvement of your primary care provider is critical. “Must not miss” disorders need to be considered prior to going forward with the recommendations given below.

Second, how do you define recurrent urinary tract infection? Most define recurrent UTI when a woman has 2 or more symptomatic urinary tract infections in 6 months or 3 or more symptomatic UTIs over 12 months. What makes this definition less precise is the fact that the degree of discomfort in the woman usually is the determining factor that leads her to present to her primary care provider. Frustration usually motivates the woman to act.

Once your primary provider has determined you have recurring UTI’s, the following recommendations may be made for young, healthy, non-pregnant women.

For sexually active women:

  • If spermicides or diphragms are used, an alternative form of contraception may be recommended.
  • Drinking fluid and urinating after sexual intercourse: studies have not proven the effectiveness of this strategy. Although some providers opine that this “doesn’t hurt,” my opinion is that if it doesn’t help, why do it?
  • Antibiotics are highly effective. There are many ways to effectively use antibiotics to prevent recurrent urinary tract infections.
  • Cranberry juice and concentrated cranberry extract tablets have not been proven to be effective. In my opinion, the cost, the calories, and the unpalatable taste make other alternatives desirable.

Antibiotic regimens:

  • Low dose antibiotics daily
  • Low dose antibiotics three times a week
  • Antibiotics after sexual intercourse
  • Alternatively, at the first sign of a urinary tract infection, when you first notice symptoms, an antibiotic is taken.

Studies have suggested these methods are efficacious for 6 months up to several years of therapy.

Does the type of antibiotic prescribed make a difference? It turns out that all antibiotics are equally effective. Some antibiotics have to be dosed for kidney disease. Antibiotics can have side effects including diarrhea and yeast infections. That’s why your primary provider is there to give you advice.

Do I have to worry about drug resistance? Yes, however it turns out that drug resistance is rare in this setting. Sometimes a urine culture is needed to see if the antibiotics are treating the organism causing the infection.

Michael Aaronson is a nephrologist who blogs at his self-titled blog, Michael L. Aaronson M.D.

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  • Thomas Gerke, M.D.

    well stated… the point..i can NOT disagree, which is a rarity in my case

  • Frustrated

    I have recurrent UTI’s. I’ve been successfully treated with prophy abx, I prefer a limited regimen and a back-up RX for onset of symptoms.

    My current Dr. doesn’t understand that Cipro is not the best or safest choice, but is squeamish about a relatively open-ended Ampicillin or Keflex Rx for dosing after intercourse, or “first onset of symptoms” treatment.

    Then he wanted me to take nifurantoin, which interacts with the medicine I take, causes headaches, has more side effects and dangers than he seems to understand, and in my experience isn’t even effective.

    I think he’s worried about resistance. I know his worry is patiently explained in most treatment guides as not a big concern in the treatment of UTI.

  • goddessoflubbock

    I am a long time diabetic who has recently started getting chronic UTI’s. I have severe neuropathy, and as a result don’t get the usual warning signs. By the time I know I’m sick, I’m in the ER in agony. I spent a week in ICU after the infection spilled out of my kidneys and caused sepsis.

    After all this, my doc refuses any preventative course aside from “hygeine and hydration” which isn’t working. After a 2nd hospitalization for this last month, I may need a new doc…

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