Ann E. Stapleton, MD, presents “Antibiotic Treatment and Prevention of Recurrent Urinary Tract Infections (UTIs).”
How to cite: Stapleton, Ann E. “Antibiotic Treatment and Prevention of Recurrent Urinary Tract Infections (UTIs).” May 2, 2025. Accessed May 2025. https://grandroundsinurology.com/antibiotic-treatment-and-prevention-of-recurrent-urinary-tract-infections-utis/
Antibiotic Treatment and Prevention of Recurrent Urinary Tract Infections (UTIs) – Summary
Diane K. Newman, DNP, ANP-BC, FAAN, FAUNA, BCB-PMD, Adjunct Professor of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, introduces Ann E. Stapleton, MD, Professor Emeritus, Internal Medicine and Infectious Disease, Eisenhower Medical Center, Palm Springs, CA, University of Washington, Seattle, Seattle, Washington. In this 23-minute presentation, infectious disease expert Dr. Stapleton provides a timely update on treating recurrent urinary tract infections in women. Drawing from recent revisions to European and anticipated US guidelines, the discussion emphasizes prudent antibiotic use and the need for antimicrobial stewardship.
The talk begins by affirming the enduring role of first-line therapies—nitrofurantoin, trimethoprim-sulfamethoxazole, and fosfomycin—while cautioning against empiric use of trimethoprim-sulfamethoxazole in areas with over 20% resistance. Stapleton introduces two newly approved agents: pivmecillinam and gepotidacin. Pivmecillinam, a beta-lactam with decades of safe use in Europe and Canada, offers broader coverage and maintains low resistance rates. Gepotidacin represents a novel class of antibiotics with dual topoisomerase inhibition, conferring a high barrier to resistance.
Stapleton cautions that these new agents should not be overused, recommending that empiric therapy should still begin with narrow-spectrum agents like nitrofurantoin for uncomplicated cystitis. She advocates obtaining urine cultures to better inform future treatment decisions, especially in recurrent cases or when resistance is suspected. As new guidelines from the Infectious Diseases Society of America are expected, the principle remains clear: select the shortest effective therapy with the narrowest spectrum, avoid premature adoption of new drugs, and always tailor treatment to culture data.
The presentation concludes with a short question-and-answer conversation between Dr. Stapleton and Diane Newman.
