女性复发性尿路感染的诊断与管理：基于现有指南的对比与解读

doi:10.12114/j.issn.1007-9572.2025.0104

中国全科医学 ›› 2026, Vol. 29 ›› Issue (17): 2387-2399.DOI: 10.12114/j.issn.1007-9572.2025.0104

女性复发性尿路感染的诊断与管理：基于现有指南的对比与解读

王奕博¹, 何凯羽¹, 梁国芬¹, 杨振华¹, 赵庭贤¹, 廖碧仪¹, 张腊¹, 刘世巍², 龚学忠³, 刘旭生¹, 古月瑜¹^,^*(), 秦新东¹^,^*(), 苏国彬¹^,⁴^,⁵^,^*()

1．510120　广东省广州市，广州中医药大学第二临床医学院肾病科　广州中医药大学第二附属医院　中医证候全国重点实验室　广东省中医药重点实验室　广东省中医药防治难治性慢性病重点实验室　广东省中医院中医药大数据研究团队，刘旭生广东名医传承工作室
2．100102　北京市，中国中医科学院望京医院肾病科
3．200071　上海市，上海中医药大学附属市中医医院肾内科
4．11228瑞典斯德哥尔摩市，卡罗林斯卡医学院流行病学和生物统计学系
5．OX1　2JD英国牛津，牛津大学纳菲尔德人群健康系

收稿日期:2025-03-20 修回日期:2025-06-28 出版日期:2026-06-15 发布日期:2026-05-21
通讯作者: 古月瑜, 秦新东, 苏国彬
作者贡献：
王奕博、古月瑜、秦新东、苏国彬负责研究结果设计、分析与解释、论文撰写与修订，对文章负责；王奕博、梁国芬负责前期文献筛选处理；何凯羽、杨振华、赵庭贤、廖碧仪负责协调数据收集；张腊、刘世巍、龚学忠、刘旭生等包括所有作者对全文共同解读与修改。
基金资助:
教育部"春晖计划"合作科研项目(HZKY20220109); 广东省中医院拔尖人才科研专项资助(BJ2022KY11); 广东省中医院中医药科学技术研究专项资助(YN2024MS012，YN2020QN18，YN2020QN24，YN2018QL08); 国家自然科学基金资助项目(82004205); 国家中医药管理局中医药防治新型冠状病毒感染应急研究专项课题(2023ZYLCYJ02-18); 2024年广东省名中医刘旭生传承工作室建设项目(粤中医办函〔2023〕108号); 深圳市"医疗卫生三名工程"项目资助(SZZYSM202206014); 广州市科技计划项目(2025A03J2702)

Diagnosis and Management of Recurrent Urinary Tract Infections in Women: a Comparison and Interpretation Based on Existing Guidelines and Evidence

WANG Yibo¹, HE Kaiyu¹, LIANG Guofen¹, YANG Zhenhua¹, ZHAO Tingxian¹, LIAO Biyi¹, ZHANG La¹, LIU Shiwei², GONG Xuezhong³, LIU Xusheng¹, GU Yueyu¹^,^*(), QIN Xindong¹^,^*(), SU Guobin¹^,⁴^,⁵^,^*()

1. Department of Nephrology, the Second Clinical Medical College/The Second Affiliated Hospital of Guangzhou University of Chinese Medicine/State Key Laboratory of Traditional Chinese Medicine Syndrome/Guangdong Provincial Key Laboratory of Chinese Medicine/Guangdong Provincial Key Laboratory of Chinese Medicine for Prevention and Treatment of Refractory Chronic Diseases/Guangdong Provincial Hospital of Chinese Medicine, Traditional Chinese Medicine Big Data Research Team, Liu Xusheng'sGuangdong Famous TCM Doctor Inheritance Studio, Guangzhou 510120, China
2. Division of Nephrology, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China
3. Department of Nephrology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, China
4. Department of Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 11228, Sweden
5. Nuffield Department of Population Health, University of Oxford, OX1 2JD, United Kingdom

Received:2025-03-20 Revised:2025-06-28 Published:2026-06-15 Online:2026-05-21
Contact: GU Yueyu, QIN Xindong, SU Guobin

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摘要/Abstract

摘要： 背景复发性尿路感染（rUTI）是女性患者常见疾病之一，严重影响患者生活质量、增加医疗负担，并与全球抗生素耐药相关。目前欧美国家针对女性rUTI带来的临床问题已形成独立的诊疗指南，但国内仍缺乏相关共识。目的总结对rUTI诊断评估、治疗策略选择、预防方案等现有证据及指南推荐，探索可供国内使用的诊疗策略。方法检索中国知网、维普网、万方数据知识服务平台、PubMed、Web of Science等中英文数据库及泌尿外科、肾科、妇产科等相关学会官方网页。纳入2014年11月—2024年11月关于女性rUTI相关指南、指南中提及的主要随机对照试验及观察性研究。结果共纳入274篇文献进行综述总结，包括98篇系统评价和Meta分析、129篇随机对照试验、15篇观察性研究以及32篇专家意见/指南。对比目前国内外rUTI临床指南，在症状管理层面，各指南普遍推荐急性发作时常规进行中段尿培养。在急性发作期抗生素治疗方面，指南推荐呋喃妥因、磷霉素和复方磺胺甲噁唑（TMP-SMX）等。足量饮水、雌激素替代、持续的低剂量抗生素疗法、免疫激活物疗法、马尿酸乌洛托品是目前证据较充分的预防措施。结论目前多数指南的建议主要针对非复杂性膀胱炎的女性群体，各国指南在急性感染时采用的抗生素方案较为一致，但在预防感染的措施方面存在不同推荐。未来的指南版本应考虑更广泛，特别是针对合并糖尿病、肾脏疾病等存在复杂性因素的rUTI人群，以优化rUTI的评估及管理。

关键词: 复发性尿路感染, 尿路感染, 女性, 指南, 干预措施

Abstract:

Background

Recurrent urinary tract infections (rUTI) are a common condition among female patients. It affects patients' quality of life, incurs the medical burden, and is associated with global antibiotic resistance. Currently, European and American countries have established clinical guidelines of rUTI to address the clinical issues. However, there is still a lack of consensus in the management of rUTI in China.

Objective

To summarize the existing evidence and guideline recommendations for the diagnosis, treatment, prevention of rUTI that can be used in China.

Methods

We conducted a systematic search in Chinese and English databases such as CNKI, VIP, Wanfang Data, PubMed, and Web of Science, as well as the associated official websites of urology, nephrology, and obstetrics and gynecology societies. We included guidelines related to female rUTI and the main randomized controlled trials and observational studies mentioned in these guidelines from November 2014 to November 2024.

Results

A total of 274 articles were included in the review, encompassing 98 systematic reviews and meta-analyses, 129 randomized controlled trials, 15 observational studies, and 32 expert opinions/guidelines. In symptom management, guidelines generally recommend routine urine culture during acute exacerbations. For acute-phase antibiotic therapy, most guidelines recommended fosfomycin and nitrofurantoin, etc. Prevention strategies such as estrogen replacement, continuous low-dose antibiotic prophylaxis, immunoactive prophylaxis, and methenamine hippurate were with relatively strong evidence.

Conclusion

Most current guidelines mainly focused on the female population with uncomplicated cystitis. Clinical guidelines from different countries demonstrate consistency in antibiotic protocols for acute infection management, yet exhibit divergence in their recommendations for infection prevention strategies. Future guidelines should consider a broader scope, especially for rUTI populations with complicative factors such as diabetes and kidney diseases, to optimize the assessment and management of rUTI.

Key words: Recurrent urinary tract infections, Urinary tract infection, Female, Guidelines, Interventional measures

中图分类号:

R 691.3

王奕博,何凯羽,梁国芬,等. 女性复发性尿路感染的诊断与管理：基于现有指南的对比与解读[J]. 中国全科医学, 2026, 29(17): 2387-2399. DOI: 10.12114/j.issn.1007-9572.2025.0104.
WANG Yibo,HE Kaiyu,LIANG Guofen, et al. Diagnosis and Management of Recurrent Urinary Tract Infections in Women: a Comparison and Interpretation Based on Existing Guidelines and Evidence[J]. Chinese General Practice, 2026, 29(17): 2387-2399. DOI: 10.12114/j.issn.1007-9572.2025.0104.

图/表 8

参考文献 87

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[64]	BRODIE A, EL-TAJI O, JOUR I, et al. A retrospective study of immunotherapy treatment with uro-vaxom(OM-89®)for prophylaxis of recurrent urinary tract infections[J]. Curr Urol, 2020, 14(3): 130-134. DOI: 10.1159/000499248.
[65]	KRAAN H, VRIELING H, CZERKINSKY C, et al. Buccal and sublingual vaccine delivery[J]. J Control Release, 2014, 190: 580-592. DOI: 10.1016/j.jconrel.2014.05.060.
[66]	CZERKINSKY C, CUBURU N, KWEON M N, et al. Sublingual vaccination[J]. Hum Vaccin, 2011, 7(1): 110-114.
[67]	CURTIS NICKEL J, SAZ-LEAL P, CHRISTOPHER DOIRON R. Could sublingual vaccination be a viable option for the prevention of recurrent urinary tract infection in Canada? A systematic review of the current literature and plans for the future[J]. Can Urol Assoc J, 2020, 14(8): 281-287. DOI: 10.5489/cuaj.6690.
[68]	LORENZO-GÓMEZ M F, FOLEY S, CURTIS NICKEL J, et al. Sublingual MV140 for prevention of recurrent urinary tract infections[J]. NEJM Evid, 2022, 1(4): EVIDoa2100018. DOI: 10.1056/EVIDoa2100018.
[69]	NESTLER S, PESCHEL C, HORSTMANN A H, et al. Prospective multicentre randomized double-blind placebo-controlled parallel group study on the efficacy and tolerability of StroVac® in patients with recurrent symptomatic uncomplicated bacterial urinary tract infections[J]. Int Urol Nephrol, 2023, 55(1): 9-16. DOI: 10.1007/s11255-022-03379-y.
[70]	EGGERS A, BALLÜER M, MOHAMED B A, et al. A suspension of inactivated bacteria used for vaccination against recurrent urinary tract infections increases the phagocytic activity of murine macrophages[J]. Front Immunol, 2023, 14: 1180785. DOI: 10.3389/fimmu.2023.1180785.
[71]	PARSONS C L, BOYCHUK D, JONES S, et al. Bladder surface glycosaminoglycans: an epithelial permeability barrier[J]. J Urol, 1990, 143(1): 139-142. DOI: 10.1016/s0022-5347(17)39897-x.
[72]	CICIONE A, CANTIELLO F, UCCIERO G, et al. Restoring the glycosaminoglycans layer in recurrent cystitis: experimental and clinical foundations[J]. Int J Urol, 2014, 21(8): 763-768. DOI: 10.1111/iju.12430.
[73]	HAUSER P J, BUETHE D A, CALIFANO J, et al. Restoring barrier function to acid damaged bladder by intravesical chondroitin sulfate[J]. J Urol, 2009, 182(5): 2477-2482. DOI: 10.1016/j.juro.2009.07.013.
[74]	REDDY M, ZIMMERN P E. Efficacy of antimicrobial intravesical treatment for uncomplicated recurrent urinary tract infections: a systematic review[J]. Int Urogynecol J, 2022, 33(5): 1125-1143. DOI: 10.1007/s00192-021-05042-z.
[75]	DAMIANO R, QUARTO G, BAVA I, et al. Prevention of recurrent urinary tract infections by intravesical administration of hyaluronic acid and chondroitin sulphate: a placebo-controlled randomised trial[J]. Eur Urol, 2011, 59(4): 645-651. DOI: 10.1016/j.eururo.2010.12.039.
[76]	OCHOA D C, HEALY R. Intravesical agents for prevention of recurrent urinary tract infections[J]. Eur Urol Focus, 2024, 10(5): 726-730. DOI: 10.1016/j.euf.2024.08.001.
[77]	NALLIAH S, FONG J S H, YI THOR A Y, et al. The use of chemotherapeutic agents as prophylaxis for recurrent urinary tract infection in healthy nonpregnant women: a network meta-analysis[J]. Indian J Urol, 2019, 35(2): 147-155. DOI: 10.4103/iju.IJU_378_18.
[78]	AHMED H, DAVIES F, FRANCIS N, et al. Long-term antibiotics for prevention of recurrent urinary tract infection in older adults: systematic review and meta-analysis of randomised trials[J]. BMJ Open, 2017, 7(5): e015233. DOI: 10.1136/bmjopen-2016-015233.
[79]	PRICE J R, GURAN L A, GREGORY W T, et al. Nitrofurantoin vs other prophylactic agents in reducing recurrent urinary tract infections in adult women: a systematic review and meta-analysis[J]. Am J Obstet Gynecol, 2016, 215(5): 548-560.
[80]	ALBERT X, HUERTAS I, PEREIRÓ I I, et al. Antibiotics for preventing recurrent urinary tract infection in non-pregnant women[J]. Cochrane Database Syst Rev, 2004, 2004(3): CD001209. DOI: 10.1002/14651858.CD001209.pub2.
[81]	EELLS S J, BHARADWA K, MCKINNELL J A, et al. Recurrent urinary tract infections among women: comparative effectiveness of 5 prevention and management strategies using a Markov chain Monte Carlo model[J]. Clin Infect Dis, 2014, 58(2): 147-160. DOI: 10.1093/cid/cit646.
[82]	EPP A, LAROCHELLE A. No. 250-recurrent urinary tract infection[J]. J Obstet Gynaecol Can, 2017, 39(10): e422-431. DOI: 10.1016/j.jogc.2017.08.017.
[83]	LICHTENBERGER P, HOOTON T M. Antimicrobial prophylaxis in women with recurrent urinary tract infections[J]. Int J Antimicrob Agents, 2011, 38(Suppl): 36-41.
[84]	SEN A Y. Recurrent cystitis in non-pregnant women[J]. BMJ Clin Evid, 2008, 2008: 0801.
[85]	CHEW L D, FIHN S D. Recurrent cystitis in nonpregnant women[J]. West J Med, 1999, 170(5): 274-277.
[86]	FISHER H, OLUBOYEDE Y, CHADWICK T, et al. Continuous low-dose antibiotic prophylaxis for adults with repeated urinary tract infections(AnTIC): a randomised, open-label trial[J]. Lancet Infect Dis, 2018, 18(9): 957-968. DOI: 10.1016/S1473-3099(18)30279-2.
[87]	JENT P, BERGER J, KUHN A, et al. Antibiotics for preventing recurrent urinary tract infection: systematic review and meta-analysis[J]. Open Forum Infect Dis, 2022, 9(7): ofac327.

问题/建议	EAU 2024^[9]	WGG 2024^[22]	AUA/CUA/SUFU 2022^[10]	SSGO 2020^[11]	SEIMC 2017^[12]	AWMF 2017^[13，21]	AAFP 2016^[14]
是否进行中段尿培养	明确初次诊断应通过尿培养确诊	对rUTI患者，尤其是疑似肾盂肾炎时，应进行尿培养以指导治疗；对非妊娠患者的非复杂性膀胱炎通常不需要常规尿培养	在对rUTI患者开始治疗之前，应在每次有症状的急性膀胱炎发作时进行中段尿培养和药敏检查	需要进行中段尿培养	早期症状复发时，需要进行中段尿培养	需要进行中段尿培养	有症状发作的情况下至少进行1次尿培养以确保诊断的准确性
是否常规进行膀胱镜检查和影像学检查	对于年龄<40岁且无危险因素的rUTI女性不作推荐	在初步诊断时并不具备显著价值，且不影响常规治疗决策。应当仅在有可能改变已知或疑似患者的治疗管理时进行	由于解剖异常的检出率低，对于单纯性rUTI患者，膀胱镜检查和上尿路影像学检查是非必要的	若每年有3次或以上的UTI，应进行膀胱镜检查以排除膀胱内病变；若每年有2次或以上的肾盂肾炎发作，应进行肾脏增强CT扫描	抗生素治疗无效、肾盂肾炎复发时和需要排除其他疾病时应进行膀胱镜检查及影像学检查	推荐常规进行泌尿彩超（若出现血尿或持续的非大肠杆菌培养阳性结果，则需要膀胱镜检查和进一步影像学检查）	不推荐常规进行膀胱镜及影像学检查。但出现反复发作的肾盂肾炎或根据培养结果进行2周抗生素治疗后仍持续存在症状及菌尿时，则建议进行

问题/建议	EAU 2024^[9]	WGG 2024^[22]	AUA/CUA/SUFU 2022^[10]	SSGO 2020^[11]	SEIMC 2017^[12]	AWMF 2017^[13，21]	AAFP 2016^[14]
是否进行中段尿培养	明确初次诊断应通过尿培养确诊	对rUTI患者，尤其是疑似肾盂肾炎时，应进行尿培养以指导治疗；对非妊娠患者的非复杂性膀胱炎通常不需要常规尿培养	在对rUTI患者开始治疗之前，应在每次有症状的急性膀胱炎发作时进行中段尿培养和药敏检查	需要进行中段尿培养	早期症状复发时，需要进行中段尿培养	需要进行中段尿培养	有症状发作的情况下至少进行1次尿培养以确保诊断的准确性
是否常规进行膀胱镜检查和影像学检查	对于年龄<40岁且无危险因素的rUTI女性不作推荐	在初步诊断时并不具备显著价值，且不影响常规治疗决策。应当仅在有可能改变已知或疑似患者的治疗管理时进行	由于解剖异常的检出率低，对于单纯性rUTI患者，膀胱镜检查和上尿路影像学检查是非必要的	若每年有3次或以上的UTI，应进行膀胱镜检查以排除膀胱内病变；若每年有2次或以上的肾盂肾炎发作，应进行肾脏增强CT扫描	抗生素治疗无效、肾盂肾炎复发时和需要排除其他疾病时应进行膀胱镜检查及影像学检查	推荐常规进行泌尿彩超（若出现血尿或持续的非大肠杆菌培养阳性结果，则需要膀胱镜检查和进一步影像学检查）	不推荐常规进行膀胱镜及影像学检查。但出现反复发作的肾盂肾炎或根据培养结果进行2周抗生素治疗后仍持续存在症状及菌尿时，则建议进行

药物	EAU 2024^[9]	WGG 2024^[22]	AUA/CUA/SUFU 2022^[10]	中国泌尿外科和男科疾病诊断治疗指南2022^[7]
磷霉素	一线推荐 3 g，1次/d，治疗1 d	一线推荐膀胱炎：单剂量；肾盂肾炎：缺乏明确疗程	一线推荐 3 g，1次/d，治疗1 d	一线推荐 3 g，隔日1次，共1~3次
呋喃妥因	一线推荐 50~100 mg，4次/d，治疗5 d	一线推荐 5 d和7 d疗程的临床效果相似	一线推荐 100 mg，2次/d，治疗5 d	一线推荐 100 mg，3次/d，治疗5 d
呋喃妥因水合物、呋喃妥因缓释剂	一线推荐 100 mg，2次/d，治疗5 d
匹美西林	一线推荐 400 mg，3次/d，治疗3~5 d	一线推荐 3 d为1个疗程
甲氧苄啶	次选药物 200 mg，2次/d，治疗5 d 禁止在妊娠早期使用
复方磺胺甲噁唑片	次选药物磺胺甲噁唑800 mg/甲氧苄啶160 mg，2次/d，治疗3 d 禁止在妊娠晚期使用	次选药物 3 d为1个疗程大部分地区耐药性增强，已不再作为一线推荐	一线推荐磺胺甲噁唑800 mg/甲氧苄啶160 mg，2次/d，治疗3 d（不建议在局部耐药率超过20%的地区经验性使用）	地区大肠杆菌耐药率<20%，可首选磺胺甲噁唑800 mg/甲氧苄啶160 mg，2次/d，3 d为1个疗程
左氧氟沙星		次选药物 3 d为1个疗程		次选药物 500 mg，1次/d，治疗3 d

药物	EAU 2024^[9]	WGG 2024^[22]	AUA/CUA/SUFU 2022^[10]	中国泌尿外科和男科疾病诊断治疗指南2022^[7]
磷霉素	一线推荐 3 g，1次/d，治疗1 d	一线推荐膀胱炎：单剂量；肾盂肾炎：缺乏明确疗程	一线推荐 3 g，1次/d，治疗1 d	一线推荐 3 g，隔日1次，共1~3次
呋喃妥因	一线推荐 50~100 mg，4次/d，治疗5 d	一线推荐 5 d和7 d疗程的临床效果相似	一线推荐 100 mg，2次/d，治疗5 d	一线推荐 100 mg，3次/d，治疗5 d
呋喃妥因水合物、呋喃妥因缓释剂	一线推荐 100 mg，2次/d，治疗5 d
匹美西林	一线推荐 400 mg，3次/d，治疗3~5 d	一线推荐 3 d为1个疗程
甲氧苄啶	次选药物 200 mg，2次/d，治疗5 d 禁止在妊娠早期使用
复方磺胺甲噁唑片	次选药物磺胺甲噁唑800 mg/甲氧苄啶160 mg，2次/d，治疗3 d 禁止在妊娠晚期使用	次选药物 3 d为1个疗程大部分地区耐药性增强，已不再作为一线推荐	一线推荐磺胺甲噁唑800 mg/甲氧苄啶160 mg，2次/d，治疗3 d（不建议在局部耐药率超过20%的地区经验性使用）	地区大肠杆菌耐药率<20%，可首选磺胺甲噁唑800 mg/甲氧苄啶160 mg，2次/d，3 d为1个疗程
左氧氟沙星		次选药物 3 d为1个疗程		次选药物 500 mg，1次/d，治疗3 d

建议	EAU 2024^[9]	AUA/CUA/SUFU 2022^[10]	SSGO 2020^[11]	NICE 2018^[33]	SEIMC 2017^[12]	AWMF 2017^[13，21]	AAFP 2016^[14]
采取期待疗法，辅以非甾体抗炎药	等待尿培养结果时与患者协商尝试	等待尿培养结果时与患者协商尝试	对于非妊娠且无并发症的患者，推荐推迟抗生素治疗48 h，并辅以非甾体抗炎药以缓解疼痛	非孕妇：48 h症状管理并预备抗生素	—	在无并发症的膀胱炎且症状为轻度至中度的情况下，在进行风险咨询后，由患者偏好决定	立即使用抗生素能带来更好临床效果。延迟抗生素治疗增加症状持续时间和诊断成本
推荐依从性高的患者进行自我诊断和治疗	强烈推荐；证据质量中等	中等推荐；证据质量低	若无易感因素^a可考虑	—	对年UTI少于3次的患者推荐，以减少预防性抗生素的使用	—	强烈推荐，减少不必要的抗生素药物使用，其是拒绝预防性抗生素的患者

女性复发性尿路感染的诊断与管理：基于现有指南的对比与解读

Diagnosis and Management of Recurrent Urinary Tract Infections in Women: a Comparison and Interpretation Based on Existing Guidelines and Evidence

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建议	EAU 2024^[9]	WGG 2024^[22]	AUA/CUA/SUFU 2022^[10]	SSGO 2020^[11]	NICE 2018^[33]	SEIMC 2017^[12]	AWMF 2017^[13，21]	AAFP 2016^[14]
非药物疗法
行为改变	弱推荐，证据有限	—	弱推荐，证据有限	推荐，但证据质量低	弱推荐，证据有限	弱推荐。若采取行为改变后无法有效预防，则没有必要坚持	强烈推荐（在长期使用预防药物之前）	弱推荐，对改善复发没有益处
口服药物疗法
持续低剂量抗生素预防	强烈推荐，证据充足且质量高	大量证据支持抗生素预防。最佳持续时间尚不明确	大量证据支持抗生素预防。有条件性推荐，证据质量中等	频繁复发情况下作为最后手段推荐	推荐，尤其是当单剂量预防无法控制症状时，NICE当前标准预防方法	强烈推荐	弱推荐	强烈推荐，证据质量高
含蔓越莓制剂	中等推荐，证据质量高（尚无明确临床证据，但不良反应小）	中等推荐，证据质量高（针对孕妇、老年人和存在膀胱排空障碍患者的研究证据不足）	有条件推荐，证据质量低	证据有限	弱推荐，证据质量不一，研究结果不一致	弱推荐，对年发作次数少的患者无效益	—	对于绝经前妇女使用蔓越莓片剂。中等推荐，证据存在矛盾性
D-甘露糖	弱推荐，总体证据质量较低	证据质量不足，无法提出明确建议	由于每种治疗的试验数量少、估计不准确和试验方法学上的缺陷，无法就其有效性得出可靠的结论。不作推荐	对拒绝或推迟抗生素治疗的患者推荐（妊娠期间不推荐）	作为自我护理治疗考虑	强烈推荐	考虑推荐	—
马尿酸乌洛托品	强烈推荐，证据质量中等	强烈推荐，证据质量高。推荐作为膀胱结构完整且无尿失禁患者的预防性性抗生素替代方案	2022年时证据不足。不作推荐，证据质量低	短期治疗时弱推荐	2022年更新。证据不足	不推荐使用。证据不足，且存在潜在的致癌风险	—	—
益生菌预防	弱推荐，目前现有证据质量低，无法就益生菌预防的入院途径、最佳剂量和治疗持续时间提出建议	证据质量不足，无法提出明确建议	不作推荐，证据不足	证据不足	不作推荐，证据质量低且结论不一致	—	—	证据有限且结论不一致
传统植物疗法	—	—	—	推荐安果心（angocin）：活性成分旱金莲和辣根中的芥子油（mustard oils from nasturtium and horseradish root）	—	—	推荐熊果叶与蒲公英根的复方，以及辣根与西洋菜草本的配伍	—
预防性免疫激活物
免疫激活物	强烈推荐，证据质量高	—	证据不足	推荐OM-89，证据质量中等	—	弱推荐（OM-89具有中等效果）	弱推荐OM-89作为其他长期使用预防措施之前	证据有限且相互矛盾结论不一致
外用疗法
膀胱内糖胺聚糖疗法（透明质酸和软骨素硫酸盐）	弱推荐，证据质量中等	—	不作推荐	推荐，证据质量高	排除在最终的指南建议之外，与干预措施的相关性差	—	—	—
局部雌激素治疗	对绝经后妇女：中等推荐，证据质量中等。存在预防趋势，但与抗生素相比效果较差且存在局部刺激和轻微出血	强烈推荐，证据质量高	中等推荐，证据质量中等	对绝经后妇女：中等推荐，证据质量低。在替代疗法无效的情况下强烈推荐，但证据有限（妊娠期间不推荐）	对绝经后妇女：使用阴道雌激素的最低有效剂量。与口服雌激素相比，阴道局部雌激素治疗的不良反应少，但与口服抗生素相比，会增加灼热、瘙痒或阴道出血的风险	强烈推荐（尤其是绝经后阴道萎缩的患者）	—	对绝经后妇女：中等推荐，证据质量低

常用阴道雌激素	组成	剂量
阴道雌激素片	雌二醇半水合物	10 μg/d，连续2周，然后2~3次/周，10 μg/次
阴道雌激素环	17β-雌二醇	2 mg环，每天释放7.5 μg，持续3个月
17β-雌二醇	17β-雌二醇	2 g/d，连续2周，然后2~3次/周，1 g/次
阴道乳膏	复合雌马酚	0.5 g/d，连续2周，然后2次/周，0.5 g/次

药物	EAU 2024^[9]	WGG 2024^[22]	AUA/CUA/SUFU 2022^[10]	SSGO 2020^[11]	NICE 2018^[33]	SEIMC 2017^[12]	AWMF 2017^[13，21]	AAFP 2016^[14]
呋喃妥因	50~100 mg/次，1次/d	50~100 mg/次，1次/d	100 mg/次，2次/d，5 d	50~100 mg/次，1次/d	100 mg/次，单剂量或50~100 mg/次，每晚用药1次（GFR≥45 mL/min）	50~100 mg/次，1次/d	50~100 mg/次，1次/d	50~100 mg/次，1次/d
磷霉素	3 g/次，1次/10 d	—	3 g/次，1次治疗或预防	3 g/次，1次/7~10 d	—	3 g/次，1次/10 d	3 g/次，1次/10 d	3 g/次，1次/10 d
甲氧苄啶	100 mg/次，1次/d	—	—	—	200 mg/次，单剂量或100 mg，每晚用药1次	100 mg/次，1次/d	100 mg/次，1次/d	100 mg/次，1次/d
头孢氨苄	125~250 mg/次，1次/d	—	—	—	—	125~250 mg/次，1次/d	125~250 mg/次，1次/d	125~250 mg/次，1次/d
头孢克洛	250 mg/次，1次/d	—	—	—	500 mg/次，单剂量或125 mg，每晚用药1次	250 mg/次，1次/d	250 mg/次，1次/d	250 mg/次，1次/d
甲氧苄啶-磺胺甲噁唑	—	40/200 mg，1次/d或3次/周	双倍标准剂量，2次/d，3 d	40/200 mg，1次/d或3次/周	—	—	—	—
阿莫西林	—	—	—	—	500 mg/次，单剂量或250 mg/次，每晚用药1次（超说明书用药）	—	—	—

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