This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
Daily antibiotics are often prescribed as a preventive treatment for women who have frequent or recurrent urinary tract infections (UTIs). In this Welsh database study, researchers found that 6% of women had recurrent UTIs over a 10-year period. Antibiotic resistant urine infections were common in this group, yet many women did not have urine tests (to identify bacteria and check for bacterial resistance to antibiotics) before being prescribed preventive antibiotics.
The researchers call for more urine testing for women with recurrent UTIs, as per international guidelines, to inform decisions about what antibiotic is best for them.
More information on UTIs can be found on the NHS website.
The issue: how are recurrent UTIs managed?
Urinary tract infections (UTIs) affect the organs involved in peeing, including the bladder, urethra (the tube that transports urine out of the body), and kidneys. Estimates vary on how common recurrent UTIs are in women (from 3% to 44% in different studies).
The National Institute for Health and Care Excellence (NICE) guidelines state that daily, low-dose antibiotics are an option for the prevention of UTIs among women who have recurrent UTIs. However, if bacteria develop resistance to this long-term treatment, the antibiotics can become ineffective and the infections difficult to treat.
Urine tests are recommended for women with, or suspected of having, recurrent UTIs. The tests can identify the presence of bacteria, and whether there is resistance to antibiotics. This informs the choice of antibiotic.
This study explored how common recurrent UTIs are in women and the use of preventive antibiotics.
What’s new?
The researchers searched a database of primary care records in Wales to find data on women who were diagnosed with recurrent UTIs (2+ in 6 months, or 3+ in a year), and women who were prescribed preventive antibiotics specifically for UTIs (trimethoprim, nitrofurantoin, or cefalexin), from 2010 to 2020. They assessed the associated urine test results from the same women from 2015 to 2020.
In total, 6% of women in the database had recurrent UTIs; 2% were prescribed preventive antibiotics. The number of women with recurrent UTIs increased around the average age of the menopause and continued to rise with age. Prescriptions for preventive antibiotics followed a similar pattern. The most common antibiotic used was trimethoprim.
The researchers found that:
- only half (49%) the women prescribed preventive antibiotics were diagnosed with recurrent UTIs before they started treatment
- most (81%) women who were diagnosed with recurrent UTIs had a urine test in the previous year
- about 2 in 3 (64%) women taking preventive antibiotics received a urine test result before starting treatment
- many women with recurrent UTIs had urine infections resistant to trimethoprim (40%) and amoxicillin (57%); some (19%) women prescribed trimethoprim as a preventive antibiotic had UTIs that were resistant to it.
Why is this important?
The researchers call for more regular urine testing before starting preventive treatment for recurrent UTIs as many women’s infections show resistance to commonly prescribed preventive antibiotics. This could help inform the choice of both short-term (treatment of UTIs) and preventive antibiotics among women with recurrent urine infections.
The study provides information about how common recurrent UTIs are among women. However, the analysis may be an underestimate as it did not include women presenting to out-of-hours general practice and accident and emergency departments if they did not require hospital admission.
What’s next?
This analysis was part of a larger project that aims to develop a decision aid to support discussions between women and clinicians about how to prevent recurrent UTIs.
Information from this study will be included in resources by the UK Health Security Agency’s TARGET (treat antibiotics responsibly, guidance, education, tools) team.
You may be interested to read
This is a summary of: Sanyaolu L, and others. Recurrent urinary tract infections and prophylactic antibiotic use in women: a cross-sectional study in primary care. British Journal of General Practice 2024; 74: e619 – e627.
Resources for clinicians on reducing antibiotic prescribing from the UK Health Security Agency’s TARGET (treat antibiotics responsibly, guidance, education, tools) team.
A Royal College of General Practitioners webinar on managing recurrent UTIs due to take place in March 2025.
A booklet for patients on frequent UTIs.
Information on taking part in NIHR research on urinary tract infections.
Funding: This study was funded by Health and Care Research Wales.
Conflicts of Interest: None declared.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
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