American Urogynecologic Society

View all recommendations from this society

Released June 24, 2020

Avoid presumptive antibiotic treatment of recurrent UTIs in women without first obtaining a UA C&S

Supporting statement: Although women with uncomplicated, infrequent UTIs can be treated empirically based on symptoms, women with recurrent
UTIs (≥3 UTIs in one year, or ≥2 in 6 months) should have a pretreatment urine specimen to document episodes and guide treatment. The use of vaginal, but not oral, estrogen in postmenopausal women is effective in reducing recurrent cystitis and should be used whenever possible. Infectious
Diseases Society of America guidelines regarding cystitis should dictate treatment, accounting for antimicrobial resistance and potential ecological
adverse effects.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The Clinical Practice Committee of the American Urogynecologic Society (AUGS) reviewed clinical evidence to identify possible topics along with suggestions for possible topics from the AUGS Board of Directors. By consensus, the Clinical Practice Committee selected the top five most overused tests within specified parameters. Additional input was sought from the AUGS Board of Directors and incorporated. The final list was reviewed and approved by the AUGS Board of Directors.

AUGS’ listing of board and committee members and conflict of interest policy can be found at


ResourcesBrubaker L, Carberry C, Nardos R, Carter-Brooks C, Lowder JL. American Urogynecologic Society Best-Practice Statement: Recurrent Urinary Tract Infection in Adult Women. Female Pelvic Medicine & Reconstructive Surgery 2018 Sep/Oct:24(5):321-335.

Anger J, Lee U, Ackerman AL, Chou R, Chughtai B, Clemons JQ, Hickling D, Kapoor A, Kenton KS, Kaufman MR, Rondanina MA, Stapleton A, Stothers L, Chai TC. Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline. 2019 Aug:202(2):282-89.

American College of Obstetricians and Gynecologists Practice Bulletin No. 91: Treatment of urinary tract infections in nonpregnant women. Obstetrics & Gynecology. 2008 Mar;111:785–94.

Gupta K, Hooton TM, Naber K, Wullt B, Colgan R, Miller LG, Moran GJ, Nicolle LE, Raz R, Schaeffer AJ, Soper DE. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clinical Infectious Diseases 2011 Mar;52(5):e103–e120.