Recurrent Urinary Tract Infections in Women
Strategies beyond repeated antibiotics.
Dr. Camille Ferraud
Internist
Burning urination, urgency, frequency, suprapubic pain. Fever or flank pain suggests pyelonephritis and warrants urgent care.
Diagnosis
Symptomatic women with a positive dipstick can be treated empirically; cultures matter for recurrences, treatment failures, or pyelonephritis.
Reducing recurrence
- Adequate water intake (at least 1.5-2 L daily)
- Post-coital voiding
- Vaginal oestrogen for postmenopausal women
- D-mannose and cranberry products: modest evidence
- Methenamine hippurate as a non-antibiotic prophylaxis
When to refer
Recurrent infections, recurrent pyelonephritis, or unusual organisms warrant urological assessment.
Self-medicating with leftover antibiotics fuels resistance: confirm the diagnosis first.
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