Recurrent urinary tract infections and prophylactic antibiotic use in women: cross-sectional study

Background Despite the considerable morbidity caused by recurrent urinary tract infections (rUTIs), and the wider personal and public health implications from frequent antibiotic use, few studies adequately describe the prevalence and characteristics of women with rUTIs or those who use prophylactic antibiotics. Aim To describe the prevalence, characteristics, and urine profiles of women with rUTIs with and without prophylactic antibiotic use in Welsh primary care. Design and setting This was a retrospective cross-sectional study in Welsh general practice using the Secure Anonymised Information Linkage (SAIL) Databank. Method The characteristics of women aged ≥18 years with rUTIs or using prophylactic antibiotics from 2010 to 2020, and associated urine culture results from 2015 to 2020, are described. Results In total, 6.0% ( n = 92 213/ N = 1 547 919) had rUTIs, and 1.7% ( n = 26 862/ N = 1 547 919) were prescribed prophylactic antibiotics with the rates increasing after 57 years of age. Only 49.0% ( n =13 149/ N = 26 862) of users of prophylactic antibiotics met the definition of rUTIs before initiation. The study found that 80.8% ( n = 44 947/ N = 55 652) of women with rUTIs had a urine culture result in the preceding 12 months with high rates of resistance to trimethoprim and amoxicillin. Of women taking prophylactic antibiotics, 64.2% ( n = 9926/ N = 15 455) had a urine culture result before initiation and 18.5% ( n = 320/ N = 1730) of women prescribed trimethoprim had resistance to it on the antecedent sample. Conclusion A substantial proportion of women had rUTIs or incident prophylactic antibiotic use. However, 64.2% ( n = 9926/ N = 15 455) of women had urine cultured before starting prophylaxis. There was a high proportion of cultured bacteria resistant to two antibiotics used for rUTI prevention and evidence of resistance to the prescribed antibiotic. More frequent urine cultures for rUTI diagnosis and before prophylactic antibiotic initiation could better inform antibiotic choices.