This handout is for recurrent uti prophylaxis & long-term management (adult women + postmenopausal + breakthrough). Your care team identified this based on: ≥2 culture-confirmed uti in 6 mo or ≥3 in 12 mo (aua/cua/sufu 2019 definition).
Other reasons your team may use this plan: recurrent uti within days of intercourse — honeymoon pattern; postcoital prophylaxis candidate; postmenopausal woman with recurrent uti → topical vaginal estrogen first-line adjunct; breakthrough uti on continuous or postcoital prophylaxis → switch agent + urology referral.
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| trimethoprim-sulfamethoxazole (continuous low-dose) | 40/200 mg (SS) PO qhs | PO | once daily at bedtime × 6–12 mo | AUA 2019 first-line continuous prophylaxis if local resistance <20% and no sulfa allergy (PMID 31042112) |
| nitrofurantoin (continuous low-dose) | 50–100 mg PO qhs | PO | once daily at bedtime × 6–12 mo | AUA 2019 first-line alternative; monitor long-term for pulmonary fibrosis (rare) + LFTs; AVOID if CrCl <30 |
| cephalexin (continuous low-dose alternative) | 125–250 mg PO qhs | PO | once daily | AUA 2019 alternative — limited evidence but acceptable when other options contraindicated |
Plan: Recurrent UTI prophylaxis — continuous low-dose + postcoital + self-start + vaginal estrogen + methenamine + cranberry + behavioural + experimental vaccines (AUA/CUA/SUFU 2019)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Annual reassessment of continuous prophylaxis; trial off after 6–12 mo; urology referral if breakthrough; postmenopausal vaginal estrogen ongoing; methenamine adherence; behavioural reinforcement (AUA 2019)
Guideline: AUA/CUA/SUFU Recurrent uncomplicated UTI in Women 2019 (Anger) + IDSA Acute Uncomplicated Cystitis/Pyelonephritis 2011 (Gupta) + cranberry meta-analysis 2021 + ALTAR methenamine non-inferiority trial + SOGC Recurrent UTI guideline (vaginal estrogen + cranberry)