Diagnosis and treatment of women with recurrent urinary tract infection

Background: Uncomplicated urinary tract infection (cystitis) is the most common bacterial infection among women visiting primary care clinics, and approximately 50% experience recurrence. Recurrent cystitis represents a substantial burden on the patients' quality of life, healthcare costs, and antibiotics overuse. Current Concepts: Symptoms remain the cornerstone of cystitis diagnosis, and urine culture is necessary if recurrent cystitis is suspected. Antibiotics (typically nitrofurantoin and fosfomycin) are the first-line treatment. Based on the resistance data, cephalosporins and amoxicillin-clavulanate are the second-line treatment recommendations. Fluoroquinolones are not the first-line options because of safety concerns and rising resistance rates. In considering patients with recurrent cystitis, it is important to assess the patient's risk factors. Postmenopausal women may present differently and require different diagnostic and treatment approaches from that of younger women. Non-antimicrobial approaches to prevent recurrent cystitis are preferred due to tolerability, safety, antimicrobial resistance concerns, and patient choice. Oral immunostimulant is effective for any age, and vaginal estrogen therapy is additionally recommended in postmenopausal women. Self-start and post-coital antibiotic therapy and non-antimicrobial prophylaxis may be combined. Low-dose continuous antibiotic therapy may be considered for women in whom other regimens fail. Discussion and Conclusion: To improve the quality of life and medical care of women, closing the gap between the physicians' perceptions and patients' needs is necessary. Furthermore, various preventive therapies for recurrent cystitis should be fully utilized.