Prophylaxis of UTI

  • The evidence base supporting antibiotic use for prophylaxis of UTI is not strong; all studies were conducted pre- 2000 and none evaluated patients beyond one year.
  • Female patients who do not have a catheter and have more than three UTIs within a 12 month period may be considered for a trial of nightly antibiotic prophylaxis with trimethoprim or nitrofurantoin. The risk of adverse effects versus the potential benefit needs to be considered carefully.
  • Long term antibiotics prescribed for UTI prophylaxis do promote resistance and there is no evidence to support their use beyond 6-12 months. Therefore ongoing clinical need should be reviewed after 6 months.
  • Cranberry products may be considered as an alternative but evidence of their efficacy is lacking.
  • In post-menopausal women consider the possibility of recurrent symptoms being associated with vaginal atrophy.