12/01/2026
RECURRENT UTI
• Antibiotic prophylaxis is recommended for women who experience two
or more symptomatic UTIs within six months or three or more over 12
months.
• The degree of discomfort experienced by the woman needs to be
considered in the decision.
• Recurrent pyelonephritis deserves prophylaxis.
• Any prophylaxis should be given after current active infection is treated.
• Prophylaxis regimen options
o Continuous: daily (sometimes three times per week)
o Postcoital: a single dose of antibiotic after every sexual activity; if there
is clear temporal relationship between episodeso Self-treatment (Not actual prophylaxis): A 3 days short course
treatment in a patient who clearly understand the symptoms. T o be
started at the first onset of symptoms. Risk of recurrence remains high.
• The antibiotic prophylaxis options
o T rimethoprim-sulfamethoxazole 40 mg/200 mg once daily or 3
times per week
o Nitrofurantoin 50 mg or 100mg once daily
o Cefaclor 250 mg once daily
o Cephalexin125 mg -250mg once daily
o Norfloxacin200 mg once daily
o Ciprofloxacin 125 mg once daily
PROST A TITIS
• Acute bacterial Prostatitis: Floroquinolones or T rimethoprim/
sulfamethoxazole is first line agent. Duration of treatment is 4 weeks (28
days).
• Chronic bacterial prostatitis: Difficult to treat. Similar antibiotics to
acute bacterial are use but for a duration of 1–4 months.
ASYMPTOMA TIC BACTERIURIA
• It should not be treated with antibiotics.
• The only two indications to treat with antibiotics: pregnancy and prior to
invasion urinary tract instrumentation.
PREGNANCY AND UTI
• Antibiotics to be avoided for pregnant women: fluoroquinolones,
aminoglycosides and trimethoprim/sulfamethoxazole
• Antibiotics recommended for uncomplicated UTI in pregnant women:
amoxicillin/clavulanate, cephalexin or cefpodoxime for 3-5 days
• Antibiotics recommended for severe or complicated scenarios: thirdgeneration cephalosporin’ s (cefotaxime or ceftriaxone).• In the presence of a risk for resistant infections: carbapenems, piperacillin-
tazobactam or cefepime or ceftazidime.
FURTHER READING
1. G. Bonkat (Chair), R. Bartoletti, F . Bruyère et al. European Association of
Urology guidelines: Urological Infections - Limited Update March 2020.
2. International Clinical Practice Guidelines for the T reatment of Acute
Uncomplicated Cystitis and Pyelonephritis in W omen: A 2010 Update
by the Infectious Diseases Society of America and the European Society
for Microbiology and Infectious Diseases. Clinical Infectious Diseases
2011;52(5): e103–e120.
