New paradigms in the management of recurrent urinary tract infections.

PURPOSE OF REVIEW: Recurrent urinary tract infections (rUTIs) represent a large burden on the healthcare system. Recent guidelines from the AUA/CUA/SUFU and advancements in the field reflect a paradigm shift for clinician and patients, steering away from empiric antibiotic therapy towards judicious antibiotic use.

RECENT FINDINGS: Antibiotic stewardship, including increasing awareness of the collateral damage of antibiotics and the risks of bacterial resistance are a major focus of the new guidelines. Accurate diagnosis of rUTIs is imperative. Urine cultures are necessary to document rUTI and should be obtained prior to any treatment. First line treatment options (trimethoprim-sulfamethoxazole, nitrofurantoin, and fosfomycin) should be used whenever possible. Asymptomatic bacteriuria should not be treated in these patients with rUTI. Although antibiotic prophylaxis methods are effective, nonantibiotic regimens show promise.

SUMMARY: The management of rUTIs has evolved significantly with the goal of antibiotic stewardship. It is increasingly important to ensure the accuracy of diagnosis with a positive urine culture in the setting of cystitis symptoms, and standardize treatment with first-line therapies to minimize antibiotic side effects.