More than half of women will develop a urinary tract infection (UTI) in their lifetimes, and many suffer recurring infections, defined as two or more UTIs in six months or three in one year. For these women, frequent use of medications to combat the infection can lead to antibiotic resistance.

New guidelines from the American Urological Association (AUA) aim to give women lasting relief by helping physicians better manage recurrent UTIs while reducing antibiotic overuse. Jennifer Anger, MD, associate director of Urological Research at Cedars-Sinai, chaired the AUA’s guideline development panel. 

"Classically, if a woman had UTI symptoms, she could call in and get a prescription for antibiotics," Anger says. "The problem with that is women suffer 'collateral damage' from too many antibiotics—side effects like risk of further infection or even musculoskeletal soreness."

Based on rigorous analysis of decades of scientific literature, the guidelines call for physicians to perform a urine culture before giving antibiotics. By allowing the culture to incubate for a few days in a lab for any bacteria to grow, physicians can be better informed about which drug will work best, or rule out infection entirely.

Designed for the care of women who are otherwise healthy and not pregnant, the new guidelines also encourage more attention be given to preventive measures. For those with a history of persistent UTIs, low-dose antibiotics at the time of sexual activity are recommended. For women in or past menopause, low-dose vaginal estrogen creams, tablets and pills can deter infection by helping regulate pH balance. Although over-the-counter cranberry supplements and juices haven’t been proven to help, they’re harmless and physicians may eventually identify the right formulation of such supplements to help patients.   

Anger says the guidelines give physicians a road map to ultimately improve care and quality of life for women frustrated by painful, frequent UTIs. 

"Patients don’t want to be overtreated with antibiotics; they’re afraid of the consequences, too," she says. "When you offer them alternatives to the standard treatment, they appreciate that."