Treatment of uncomplicated urinary tract infections in an era of increasing antimicrobial resistance.
In the past few years, notable advances have occurred in our understanding of the epidemiology and clinical importance of drug resistance among uropathogens that cause uncomplicated urinary tract infections (UTIs) or cystitis. Guidelines recommend trimethoprim-sulfamethoxazole for empirical treatment of uncomplicated UTI unless trimethoprim-sulfamethoxazole resistance in a community exceeds 10% to 20%. The rationale for this 10% to 20% cutoff appears to be related to clinical and economical considerations and to concerns about the emergence of fluoroquinolone-resistant bacteria. In patients with uncomplicated UTIs caused by uropathogens resistant to trimethoprim-sulfamethoxazole who were treated with this drug combination, clinical outcomes were clarified recently and found to be suboptimal (<60% clinical cure). Following guidelines for empirical treatment of uncomplicated UTIs is problematic. Surveillance of antimicrobial resistance among uropathogens that cause uncomplicated UTIs is performed rarely. Hospital antibiograms provide data on resistance among bacteria that cause community-associated UTIs; however, antibiograms overestimate drug resistance among uropathogens that cause UTIs and may mislead clinicians about the prevalence of local resistance. We review options for management of uncomplicated UTIs in light of these considerations.
Division of Infectious Diseases and the Research and Education Institute, Harbor-UCLA Medical Center, Torrance, Calif 90509, USA. lgmiller@rei.edu
Loren G
LG
Miller
Angela W
AW
Tang
D000892:Anti-Infective Agents, Urinary / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D015982:Bias; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D024841:Fluoroquinolones; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards; D008826:Microbial Sensitivity Tests / Q000379:methods / Q000592:standards; D018579:Patient Selection; D017891:Pharmacoepidemiology; D011159:Population Surveillance / Q000379:methods; D017410:Practice Guidelines as Topic; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014296:Trimethoprim Resistance; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology
D000892:Anti-Infective Agents, Urinary; D024841:Fluoroquinolones; D015662:Trimethoprim, Sulfamethoxazole Drug Combination