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TIDBSI: Antibiotics for Recurrent UTIs

Vanessa Gervais, MD and Adrien Selim, MD
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No me gusta!

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What do we usually do when a female patient comes to us with recurrent UTIs? And should we be doing this? Our Things I Do But Should I duo, Vanessa and Adrien, are here to share pearls for the prophylaxis and management of recurrent UTIs.

 

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Vaibhav D. -

Do we need to order any kind if imagings to rule out any stones or malignancies? Is there any literature that says that. Thanks in advance.

Neda F., MD -

Hi Vaibhav. In most cases, imaging isn't necessary. Routine imaging is discouraged by most societies, whether ID or OB/GYN or Radiology. However, a renal US or potentially CT A/P can be considered if a patient has relapsing infections, recurrent Proteus infections (pointing to nephrolithiasis), a known history of stones, known anatomic abnormalities, or if they're immunocompromised. Here are some resources: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202002/ and https://www.aafp.org/afp/2010/0915/p638.html -- Neda

Katie D. -

Hi there,
I love (and just today advised) the third option of patient initiated treatment.
Was wondering what regimen is followed if this option is chosen? (I realize there are no guidelines for this recommendation, so personal preference is fine).
A full "normal" course of antibiotics with each UTI? Or a shorter course/ decreased strength?
Ex. 100mg Macrobid BID for 5 days with each UTI?
Thanks so much for your time! (First time writing in and I LOVE the show!!)
Katie D, NP up in Canada

Neda F., MD -

Hi Katie. So happy to hear from you! Here's Vanessa's response: "For patient initiated treatment you need to give regular full dose treatment as you would with any new UTI diagnosed in the office. So yes, 100mg macrobid bid x 5 days is a perfect option." Good luck and hope this helps! -- Neda

Katie D. -

Amazing - thanks so much for the speedy response!
Katie

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Primary Care Gets Some Love Full episode audio for MD edition 196:25 min - 92 MB - M4AHippo Primary Care RAP - August 2019 Written Summary 659 KB - PDF

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