title: Choice of antibiotic for empirical therapy of acute cystitis in a setting of high antimicrobial resistance.
abstract: BACKGROUND
  A high prevalence of antimicrobial resistance among urinary isolates in the Garhwal region of Uttaranchal.
  
  
  OBJECTIVE
  To identify the most appropriate antibiotic for empirical treatment of community-acquired acute cystitis on the basis of local antimicrobial sensitivity profile.
  
  
  METHODS
  A prospective clinico-microbiological study including all clinically diagnosed patients with community acquired acute cystitis attending a tertiary care teaching hospital over a period of three years.
  
  
  METHODS
  Clean-catch midstream urine specimens, from 524 non-pregnant women with community-acquired acute cystitis, were subjected to semi-quantitative culture and antibiotic susceptibility by the Kirby- Bauer disc diffusion method. A survey was also conducted on 30 randomly selected local practitioners, to know the prevalent prescribing habits in this condition.
  
  
  METHODS
  The difference between the susceptibility rates of E. coli isolates to Nitrofurantoin and the other commonly prescribed antibiotics was analysed by applying the z test for proportion.
  
  
  RESULTS
  354 (67.5%) specimens yielded significant growth of E. coli.> 35% of the urinary E.coli isolates were resistant to the fluoroquinolones, which were found to be the most commonly used empirical antibiotics in acute cystitis. Resistance was minimum against Nitrofurantoin (9.3%, 33) and Amikacin (11.0%,39).> 80% of the fluoroquinolone-resistant strains were found to be sensitive to Nitrofurantoin.
  
  
  CONCLUSIONS
  The best in vitro susceptibility profile in our study has been shown by Nitrofurantoin and a significantly high proportion of the urinary E. coli isolates have already developed resistance to the currently prescribed empirical antibiotics, viz. the fluoroquinolones. In view of these in vitro susceptibility patterns, a transition in empirical therapy appears imminent.
authors.affiliation: Department of Microbiology, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Jolly Grant, Dehradun, India. dbiswas71@rediffmail.com
authors.forename: Debasis
authors.initials: D
authors.lastname: Biswas
authors.forename: Pratima
authors.initials: P
authors.lastname: Gupta
authors.forename: Ramjee
authors.initials: R
authors.lastname: Prasad
authors.forename: Vikram
authors.initials: V
authors.lastname: Singh
authors.forename: Muktanjali
authors.initials: M
authors.lastname: Arya
authors.forename: Ashish
authors.initials: A
authors.lastname: Kumar
mesh_terms: D000208:Acute Disease; D000328:Adult; D000892:Anti-Infective Agents, Urinary / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy; D003556:Cystitis / Q000188:drug therapy / Q000382:microbiology*; D004352:Drug Resistance, Microbial; D004926:Escherichia coli / Q000187:drug effects; D005260:Female; D006801:Humans; D007194:India; D007709:Klebsiella / Q000187:drug effects; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009582:Nitrofurantoin / Q000627:therapeutic use*; D011446:Prospective Studies; D011511:Proteus / Q000187:drug effects; D013210:Staphylococcus / Q000187:drug effects; D014556:Urine / Q000382:microbiology
chemical_list: D000892:Anti-Infective Agents, Urinary; D009582:Nitrofurantoin