Recurrent UTI Prevention — MRCGP AKT MCQ

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ModerateUrologyRecurrent UTI PreventionMRCGP AKT

A 52-year-old postmenopausal woman has had three culture-confirmed episodes of uncomplicated lower urinary tract infection in the past 12 months. She is currently asymptomatic, and behavioural and personal hygiene measures have not reduced the frequency of infections. Assessment has identified no features of recurrent upper or complicated UTI. Which preventive intervention should be considered next?

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Correct answer: A — Vaginal oestrogen

A is correct. NICE recommends considering vaginal oestrogen for recurrent UTI in postmenopausal women when behavioural and personal hygiene measures have been ineffective or are inappropriate. Vaginal preparations have minimal systemic absorption, and treatment should be reviewed within 12 months. Cranberry products may be tried, but evidence of benefit is uncertain; evidence for Lactobacillus probiotics is inconclusive. High-dose vitamin C is not recommended as evidence-based prophylaxis. Daily nitrofurantoin is an effective antibiotic option in selected patients, but continuous antibiotic prophylaxis is considered later, after assessing cultures, resistance, adverse effects and whether earlier measures such as vaginal oestrogen, trigger-linked prophylaxis or methenamine hippurate are appropriate.

Reference: National Institute for Health and Care Excellence. NG112, Urinary tract infection (recurrent): antimicrobial prescribing, section 1.2 Treatments for preventing recurrent UTI and section 1.3 Self-care. Updated 2024. https://www.nice.org.uk/guidance/ng112/chapter/recommendations