recurrent urinary tract infections by EAU 2024

recurrent urinary tract infection from European association guidelines 2024

1. rUTI

2. 3/ yr 2/6month Initial diagnosis of rUTI should be confirmed by urine culture.

3. Young and pre-menopausal women Post-menopausal and elderly women Sexual intercourse Use of spermicide A new sexual partner A mother with a history of UTI History of UTI during childhood Blood group antigen secretory status History of UTI before menopause Urinary incontinence Atrophic vaginitis due to oestrogen deficiency Cystocele Increased post-void urine volume Blood group antigen secretory status Urine catheterisation and functional status deterioration in elderly institutionalised women

4. Behavioural modifications:   Women with rUTI should be counselled on avoidance of risks (e.g., insufficient drinking, habitual and post-coital delayed urination, wiping from back to front after defecation, douching and wearing occlusive underwear) before initiation of long-term prophylactic drug treatment, 

5. Hormonal rx n immune actice rx : All studies reported that application was superior compared to placebo but was inferior compared to antibiotics.   oral immunotherapy with OM-89 is an effective and safe method for the prevention of rUTIs compared to placebo

6. Probiotics: The highest efficacy was shown with  L. rhamnosus  GR-1,  L. reuteri  B-54,  L. reuteri  RC-14,  L. casei shirota , and  L. crispatus  CTV-05

7. Cranberry: A RCT of 145 women randomised to high-dose vs. low-dose cranberry proanthocyanidin extract reported no significant reduction in the number of symptomatic UTI episodes. may recommend them for rUTI prevention in women who are informed of the weak evidence base due to their favourable benefit to harm ratio. However, there is no clear clinical evidence regarding the appropriate dose and treatment duration.

8. The absolute difference was 0.49 confirming that methenamine hippurate was not inferior to antibiotic prophylaxis Haluronic acid n chondartin sulphate D manose

9. It is mandatory to offer both continuous low-dose antimicrobial and post-coital prophylaxis after counselling, and when behavioural modifications as well as non-antimicrobial measures have been unsuccessful. Self-diagnosis and self-treatment