Introduction <p>Our aim was to describe the rate of unnecessary antibiotic prescriptions across specialties and the frequency of clinical scenarios in which the unnecessary antibiotics were prescribed in older female patients with recurrent urinary tract infections (UTI).</p> Methods <p>This was a retrospective cohort study of female patients 65 or older with a clinical diagnosis of recurrent UTI. An unnecessary antibiotic was defined as an antibiotic prescribed (i) for asymptomatic bacteriuria (positive culture in the absence of UTI-specific symptoms), (ii) in the absence of UTI-specific symptoms, or (iii) in the presence of documented negative urine culture or negative pyuria. Data on clinical scenarios during episodes when an unnecessary antibiotic was prescribed (such as symptom documentation, urine testing) were extracted and described.</p> Results <p>The overall rate of unnecessary antibiotics across 454 episodes of antibiotic prescriptions in 175 older female patients with recurrent UTI was 41% and did not significantly differ between specialties (primary care 45%, urogynecology 41%, obstetrics-gynecology 29%, urology 28%, urgent care 27%, <i>p</i> = 0.06). The commonest clinical scenario during which an unnecessary antibiotic was prescribed was absence of documented UTI-specific symptoms (60%) followed by asymptomatic bacteriuria (46%). Other clinical scenarios associated with unnecessary antibiotics included antibiotics prescribed with documented negative pyuria (32%) or negative urine culture (18%). In 11% of episodes, antibiotics were prescribed without any documented UTI-specific symptom and without any testing.</p> Conclusion <p>Inadequate symptom documentation and inappropriate urine testing contribute to a high rate of unnecessary antibiotic prescribing in older female patients with recurrent UTI. Clinical decision support tools that address these gaps could promote antibiotic stewardship.</p>