What medications are used for persistently recurrent Urinary Tract Infections (UTIs)?

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Last updated: February 19, 2025 • View editorial policy

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From the Guidelines

For persistently recurrent urinary tract infections (UTIs), antibiotic prophylaxis is recommended, with options including Trimethoprim-sulfamethoxazole (40 mg/200 mg once daily) or Nitrofurantoin (50 mg or 100 mg daily) for 6-12 months, as supported by 1.

  • Alternative options include:
    • Cephalexin (250 mg) or Ciprofloxacin (250 mg) taken once daily at bedtime for 6-12 months, as suggested by 1.
    • Methenamine hippurate (1 gram) taken twice daily for 6-12 months, which has been found to be noninferior to antibiotics for UTI prevention, as shown in 1.
  • Self-initiated treatment with a 3-day course of Trimethoprim-sulfamethoxazole (160/800 mg) or Nitrofurantoin (100 mg) at the onset of symptoms is also an option for patients with a history of recurrent UTIs, as recommended by 1.
  • Postcoital prophylaxis with a single dose of Trimethoprim-sulfamethoxazole (40 mg/200 mg) or Nitrofurantoin (50 mg or 100 mg) may be considered for women with UTIs related to sexual activity, as suggested by 1. It is essential to note that the decision to use antibiotic prophylaxis must balance the need for prevention against the risk of adverse drug events, antimicrobial resistance, and microbiome disruption, as highlighted in 1.

From the FDA Drug Label

Methenamine Hippurate Tablets are indicated for prophylactic or suppressive treatment of frequently recurring urinary tract infections when long-term therapy is considered necessary.

The recommended dosage for prophylaxis in adults is 1 sulfamethoxazole and trimethoprim DS (double strength) tablet daily

  • Medications used for persistently recurrent Urinary Tract Infections (UTIs):
    • Methenamine Hippurate Tablets 2
    • Trimethoprim-sulfamethoxazole (for prophylaxis) 3 Note: Ciprofloxacin is indicated for the treatment of complicated urinary tract infections and pyelonephritis, but it is not specifically mentioned for prophylactic or suppressive treatment of frequently recurring UTIs 4

From the Research

Medications for Recurrent UTIs

The following medications are used to treat persistently recurrent Urinary Tract Infections (UTIs):

  • Nitrofurantoin: used as a prophylactic antibiotic to prevent recurrent UTIs 5, 6, 7, 8
  • Trimethoprim/sulfamethoxazole (Bactrim): used as a prophylactic antibiotic to prevent recurrent UTIs 6, 7
  • Amoxicillin clavulanic acid: used as a prophylactic antibiotic to prevent recurrent UTIs 6
  • Cephalexin: used as a prophylactic antibiotic to prevent recurrent UTIs 7
  • Cinoxacin: used as a prophylactic antibiotic to prevent recurrent UTIs 7
  • Pivmecillinam: used as an oral therapy to treat uncomplicated UTIs caused by ESBL infection 5
  • Fosfomycin: used as an oral therapy to treat uncomplicated UTIs caused by ESBL infection 5
  • Ceftolozane-Tazobactam: used to treat UTIs caused by ESBL infection 5
  • Ceftazidime-Avibactam: used to treat UTIs caused by ESBL infection 5
  • Cefepime: used to treat UTIs caused by ESBL infection 5
  • Piperacillin-Tazobactam: used to treat UTIs caused by ESBL infection 5
  • Colistin: used as a backbone to treat CRE-UTIs 5
  • Methenamine hippurate: may decrease the number of symptomatic UTIs 5
  • Cranberry: may decrease the number of symptomatic UTIs 5
  • Oral D-mannose: may decrease the number of symptomatic UTIs 5
  • Uro-Vaxom: an oral vaccine that may reduce the number of UTIs 5
  • Intravaginal estrogen therapy: may prevent recurrent UTIs in postmenopausal women 5, 6

Dosage and Administration

The dosage and administration of these medications may vary depending on the specific condition and patient population. For example:

  • Nitrofurantoin: 50 mg or 100 mg daily as prophylaxis for recurrent UTIs 8
  • Trimethoprim/sulfamethoxazole: dosage not specified in the studies 6, 7
  • Amoxicillin clavulanic acid: dosage not specified in the studies 6
  • Cephalexin: dosage not specified in the studies 7
  • Cinoxacin: dosage not specified in the studies 7
  • Pivmecillinam: dosage not specified in the studies 5
  • Fosfomycin: dosage not specified in the studies 5
  • Ceftolozane-Tazobactam: dosage not specified in the studies 5
  • Ceftazidime-Avibactam: dosage not specified in the studies 5
  • Cefepime: dosage not specified in the studies 5
  • Piperacillin-Tazobactam: dosage not specified in the studies 5
  • Colistin: dosage not specified in the studies 5
  • Methenamine hippurate: dosage not specified in the studies 5
  • Cranberry: dosage not specified in the studies 5
  • Oral D-mannose: dosage not specified in the studies 5
  • Uro-Vaxom: dosage not specified in the studies 5
  • Intravaginal estrogen therapy: dosage not specified in the studies 5, 6

Treatment Strategies

The treatment strategies for recurrent UTIs may include:

  • Continuous prophylaxis: daily administration of a prophylactic antibiotic to prevent recurrent UTIs 5, 6, 7, 8
  • Post-coital prophylaxis: administration of a prophylactic antibiotic after sexual intercourse to prevent recurrent UTIs 5
  • Intermittent self-treatment: self-administration of an antibiotic at the onset of UTI symptoms to prevent recurrent UTIs 5
  • Non-antimicrobial options: use of non-antimicrobial agents such as cranberry, Methenamine hippurate, and oral D-mannose to prevent recurrent UTIs 5

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

8
Research

Nitrofurantoin 100 mg versus 50 mg prophylaxis for urinary tract infections, a cohort study.

Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2022

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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