Recurrent urinary tract infections

Recurrent UTI in adults is defined as repeated UTI with a frequency of 2 or more UTIs in the last 6 months or 3 or more UTIs in the last 12 months (1).

Recurrent UTI is diagnosed in children and young people under 16 years if they have (1):

• 2 or more episodes of UTI with acute pyelonephritis/upper UTI or
• 1 episode of UTI with acute pyelonephritis plus 1 or more episode of UTI with cystitis/lower UTI or
• 3 or more episodes of UTI with cystitis/lower UTI

Urinary tract infection (UTI) is defined as (1):

• typical symptoms of infection (such as dysuria, nocturia, change in urine appearance or odour) with a clinical response to antibiotics, even in the
  absence of microbiological confirmation, or,
• typical symptoms of infection with a positive urine dipstick (positive for nitrite or leukocyte and red blood cells), or,
• typical symptoms of infection with a positive urine culture

Urinary tract infection (UTI) is defined as (2):

• typical symptoms of infection (such as dysuria, nocturia, change in urine appearance or odour) with a clinical response to antibiotics, even in the
  absence of microbiological confirmation, or,
• typical symptoms of infection with a positive urine dipstick (positive for nitrite or leukocyte and red blood cells), or,
• typical symptoms of infection with a positive urine culture

It may be necessary for some patients to be on long-term low dose therapy in order to prevent recurrence of infection.

Trimethoprim and nitrofurantoin have been indicated for long term use in these instances.

Other factors should be considered (see linked options).

Reference:

1. NICE (December 2024). Urinary tract infection (recurrent): antimicrobial prescribing
2. Academy of Medical Royal Colleges on behalf of the Evidence-based Interventions Programme Board (January 2024). Evidence-based Interventions Clinical guidance Release 4 - Urology