Prophylaxis for Recurrent Urinary Tract Infections: Nitrofurantoin, Not Trimethoprim-Sulfamethoxazole or Cranberry Juice—Reply

In reply

We appreciate the opportunity to respond to the letter from Dr Cunha. Two important issues are raised: episodic treatment vs prophylaxis for recurrent urinary tract infections (UTIs) and the choice of the antibiotic prophylaxis.

Effective prevention strategies for recurrent UTIs are particularly relevant for women at high risk for recurrence. In our study population the median recurrence rate in the year preceding inclusion was approximately 6 to 7 (mean number of symptomatic UTIs).¹ In these women episodic treatment of recurrences instead of prevention causes significant discomfort and would have a high impact on ambulatory health care costs as a result of primary care and outpatient visits, diagnostic tests, and prescriptions.² Continuous prophylaxis, postcoital prophylaxis with low-dose antibiotics, and intermittent self-treatment have all been demonstrated to be effective in managing recurrent UTIs in women.³ We chose continuous prophylaxis based on a trial from Wong et al⁴ in which self-treatment was less effective than continuous prophylaxis while the costs were similar.