Manage recurrent urinary tract infections (UTIs) by ensuring appropriate treatment of acute episodes, with urine culture and sensitivities sent before antibiotics are prescribed NICE CKS.
Consider non-antibiotic measures for prevention, such as maintaining adequate hydration (about 1.5 L/day), avoiding douching, wearing breathable underwear, wiping from front to back, and avoiding delay in urination NICE CKS.
Do not routinely prescribe antibiotics for asymptomatic bacteriuria in non-pregnant women with recurrent UTI NICE CKS.
Arrange further investigation and consider referral to a urologist if there is an underlying cause needing specialist assessment, such as renal or ureteric stones, interstitial cystitis, or urogynaecological cancer NICE CKS.
Refer or seek specialist advice for recurrent upper UTI, when the cause is unknown, or if there are features suggestive of underlying pathology NICE CKS.
In women aged 60 years and over with unexplained recurrent or persistent UTI, consider a non-urgent urological referral for bladder cancer assessment NICE CKS.
In men, trans women, and non-binary people with recurrent lower UTI, consider referral if symptoms persist despite initial management, or if investigations reveal underlying pathology NICE CKS.
Referral should also be considered if there are red flags such as haematuria, unexplained persistent symptoms, or suspicion of malignancy, following NICE guidelines on suspected cancer NICE CKS.