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AUA Releases First Guidelines for Uncomplicated Recurrent UTI

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Originally published in Medscape

In This Article

  • New guidelines for the treatment and diagnosis of recurring urinary tract infection (rUTI) draw from decades of research
  • The guidelines include clarified recommendations for clinicians regarding the treatment of asymptomatic bacteriuria
  • Ajay Singla, MD, says that the new guidelines would clarify grey areas and affirm best practices in care for rUTIs

In May 2019, the American Urological Association (AUA) issued the first guidelines for the diagnosis and treatment of recurrent urinary tract infections (rUTIs).

The AUA states that the new guidelines have evolved over several decades in response to a deeper understanding of the pathophysiology, natural history and clinical outcomes of acute cystitis and rUTI. In addition to several recommendations for care, the new guidelines also emphasize the importance of cultures in the diagnosis and treatment of rUTIs, as well as their effectiveness in ruling out compounding infections.

In an interview with Medscape, Ajay Singla, MD, a specialist in urinary incontinence and voiding dysfunction in both men and women in the Department of Urology at Massachusetts General Hospital, said that the guidelines will not necessarily change practices, but rather affirm existing practices in the treatment of rUTIs and clarify gray areas. He explained that even for physicians who were already following the guidelines, it helps to know that you are doing the right thing.

The new guidelines advise clinicians against treating asymptomatic bacteriuria (ABU). Dr. Singla said that in the past there have not been clear guidelines on the costs and benefits of treating ABU. The AUA's recommendation against treatment is based on evidence that treating ABU can cause adverse effects, infection and antibiotic resistance.

Dr. Singla also commented on AUA's approval of cranberry as antibiotic prophylaxis for women with rUTIs, saying that while he has been less positive about the supporting evidence for the method, he will now consider it further, especially given that there is no risk to cranberry in non-juice form.

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