News: AUA releases first “uncomplicated recurrent UTI” guideline

The American Urological Association (AUA) recently issued a guideline for the diagnosis and treatment of uncomplicated recurrent urinary tract infections (UTIs), which emphasizes the importance of cultures and antibiotic stewardship, Medscape Medical News reported.

Jennifer Anger, MD, from the Cedars-Sinai Medical Center in Los Angeles, who chaired the guideline-development committee, presented highlights and themes of the guideline at the AUA 2019 Annual Meeting.

“We really felt as a panel that cultures were quite central to the care, abatement, and treatment of recurrent urinary tract infections,” Anger said. And, cultures are necessary for diagnosis and for ruling out confounding infections, she added.

The mandate for antibiotic stewardship is a strong theme in the guideline, Medscape Medical News reported. When patients present with infections, “we need to provide the shortest course of an antibiotic that has the least systemic effect on the rest of their body,” Anger explained.

The guideline recommends, on the basis of expert opinion, that when UTI symptoms persist after antibiotic therapy, clinicians repeat the urine culture to guide management.

The use of cranberry as prophylaxis is a conditional recommendation. The mechanism of action is thought to be related to the ability of the proanthocyanidins in cranberries to prevent bacteria from adhering to the urothelium.

The use of vaginal estrogen treatment to mitigate future UTI risk in peri- and postmenopausal women with recurrent UTIs is a moderate recommendation as well.

Outside the formal recommendations, the panel agreed that intermittent courses of higher-dose antibiotics are more harmful to patients than a course of prophylactic antibiotics coupled with counseling on risk when UTIs continue to recur. Patients might be more flexible than physicians think, Anger said. In addition, physicians often underestimate the psychosocial effects of the condition, which include guilt and shame.

The guideline is not necessarily practice-changing but it is affirming, Ajay Singla, MD, from Harvard Medical School and Massachusetts General Hospital in Boston, told Medscape Medical News.

"It's helpful to know that we are following the guidelines," he said.

Editor’s note: To read Medscape Medical News’ extended coverage of this story, click here. To read the full guideline, click here.