Update information
December 2024: We have reviewed the evidence and made new recommendations on methenamine hippurate for people with recurrent UTI. These recommendations are marked [2024].
We have also amended the recommendations on referral and seeking specialist advice, choice of antibiotic or antiseptic prophylaxis, and oestrogens without an evidence review. These changes were made to:
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reflect current practice, including the potential use of methenamine hippurate
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bring the language up to date
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for oestrogens, remove specific references to the 'lowest effective dose of vaginal oestrogen' and to 'estriol cream', and to bring the recommendations in line with the 2024 version of NICE's guideline on menopause.
These recommendations are marked [2018, amended 2024].
Recommendations marked [2018] last had an evidence review in 2018. In some cases, minor changes have been made to the wording to bring the language and style up to date, without changing the meaning.
Minor updates since publication
May 2025: We updated the tables on choice of antibiotic or antiseptic prophylaxis to clarify that the use of cefalexin for preventing recurrent upper UTI or complicated lower UTI is off label. We also added links to the MHRA advice on monitoring for pulmonary and hepatic adverse reactions to nitrofurantoin.
February 2019: Minor corrections to one of the evidence summaries.
ISBN: 978-1-4731-6686-8