Recurrent UTI in non-pregnant Women ≥ 3 UTIs/year

2 in 6 months or 3 or more per year

First line: advise simple measures including hydration; ibuprofen for symptom relief.

Cranberry products work for some women.

Second Line: Stand by or post-coital antibiotics.

Third line: antibiotic prophylaxis. (Risk of pulmonary fibrosis in patient taking long term nitrofurantoin). Consider methenamine  (1g BD for 6 months and review) if no renal/hepatic impairment.

nitrofurantoin

50–100mg

Post coital stat (off-label)

Prophylaxis OD at night review at 6 months

or trimethoprim

100mg

Post coital stat (off-label)

Prophylaxis OD at night review at 6 months