Adult with recurrent UTI (≥2 uncomplicated UTIs in 6 months or ≥3 in 12 months). Action: confirm the diagnosis with urinalysis and urine culture before treating, exclude treatable causes and exhaust non-antibiotic measures before proposing prophylaxis.
High fever with chills, flank pain or nausea → suspect pyelonephritis and refer. Macroscopic haematuria, pelvic pain or UTI in men → investigate urological/structural causes. Persisting recurrence despite prophylaxis → reassess.
Recurrence: ≥2 uncomplicated UTIs in 6 months or ≥3 in 12 months. Confirm with urinalysis (nitrites, leucocytes) and urine culture before starting an antibiotic. Without culture, bacterial recurrence cannot be assumed.
Sexual intercourse, spermicides, urinary obstruction, decompensated diabetes, menopause. UTI in men, haematuria or persistent recurrence: consider a urological cause and refer.
Adequate hydration, post-coital voiding and hygiene habits. D-mannose 2 g/day or cranberry extract may reduce recurrence. Topical vaginal oestrogen in post-menopause (medical decision).
If recurrences continue despite non-antibiotic measures: continuous prophylaxis (e.g. nitrofurantoin 50 mg/day or trimethoprim) or post-coital, for 6–12 months. Review the indication periodically.
Long-term antibiotic prophylaxis is a medical decision and should be reviewed every 6–12 months. Nitrofurantoin is contraindicated when eGFR < 30 mL/min. Do not use antibiotic prophylaxis in pregnancy without specialist guidance.
DGS Guideline — Urinary Tract Infection: Diagnosis and Treatment in Primary Care
Official source