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Use of antibiotics to prevent recurrent urinary tract infection (UTI)

When structural problems in the urinary tract have been excluded, antibiotics are the mainstay of treatment of recurrent urinary tract infection (UTI).

There are several forms of antibiotic usage that can help reduce the rate of recurrent UTIs in women including:

  • Low dose continuous antibiotic prophylaxis
    • This involves taking a very small dose of antibiotic continuously over several months.
    • The rationale is to eradicate certain bacteria that cause UTI which live on the skin and in the bowel.
    • Low dose continuous antibiotics can also help treat reservoirs of bacteria that may hide inside cells in the wall of the bladder.
  • After intercourse (post coital) antibiotic prophylaxis
    • In women in whom UTIs are consistently triggered by sexual intercourse, use of a single low dose of antibiotic immediately after intercourse can reduce the rate of UTI.
  • Self-start” antibiotic courses
    • Suitable for women with occasional UTIs who are able to have an MSU specimen taken before starting a short course of oral antibiotic which has already been prescribed.
      • Pathology request forms for an MSU can be obtained from the GP as well as the necessary antibiotic scripts so that the patient is prepared if symptoms arise.
      • It is important that the urine specimen is performed BEFORE any antibiotics are taken.
      • Antibiotics can be started immediately with the onset of symptoms before the results of the MSU culture are available.
    • The antibiotic can then be changed according to the result of the MSU specimen when it becomes available after about 48 hours.

Although understandably many women do not like the idea of being on long-term antibiotics, this is often much safer and healthier than suffering from ongoing infections. In many women a course of preventative antibiotics used over several months can help break the cycle of frequent UTIs for many months or even years.