When UTIs keep coming back, the right next step is a workup — not another prescription.
Most UTIs are uncomplicated and resolve with a short antibiotic course. Recurrent UTIs (typically defined as two within six months or three within a year) are different. They warrant a focused urologic evaluation to identify what's driving recurrence, before reflexively cycling through antibiotics that select for resistance.
When recurrent UTIs need urologic evaluation
Recurrence pattern, post-void residual urine measurement, urinalysis with culture and sensitivity, and imaging when indicated. In men, a recurrent UTI almost always warrants evaluation regardless of frequency. In women, recurrent UTIs need a workup beyond repeat antibiotic prescriptions.
Treatment plans that reduce recurrence
Targeted antibiotic selection based on culture data, not empiric defaults. Behavioral and hydration adjustments. Vaginal estrogen for postmenopausal women, where evidence is strong. Selective long-term suppression or post-coital prophylaxis when patterns warrant it. Methenamine and other non-antibiotic options where appropriate.
Common questions
Should I just keep taking antibiotics?
Unsupervised repeat antibiotic use selects for resistant bacteria and can mask the underlying cause. A focused urologic evaluation usually reduces both the recurrence rate and the antibiotic burden.
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