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Recurrent UTI Prevention — SCE Infectious Diseases MCQ

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EasyAntimicrobial StewardshipRecurrent UTI PreventionSCE Infectious Diseases

A 32-year-old woman with recurrent urinary tract infections (4 in 12 months) asks about non-antibiotic prevention strategies. She has tried cranberry products without benefit. What evidence-based non-antibiotic intervention can be offered?

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Correct answer: E — Vaginal oestrogen cream (if postmenopausal) or D-Mannose supplementation; ensure adequate hydration and post-coital voiding

For recurrent UTI in women, NICE and EAU guidelines recommend behavioural measures (adequate hydration, post-coital voiding, avoiding spermicides) as first-line prevention. Vaginal oestrogen cream is effective in postmenopausal women by restoring Lactobacillus-dominant vaginal flora. D-Mannose (2 g daily) has evidence from RCTs showing reduction in UTI recurrence, likely by inhibiting E. coli adherence to uroepithelium. Methenamine hippurate is another non-antibiotic option with growing evidence. Low-dose antibiotic prophylaxis (Nitrofurantoin, Trimethoprim) is effective but reserved for persistent recurrence despite non-antibiotic measures.

Reference: NICE NG112 2018 – Recurrent UTI; EAU 2024 – Urological infections