Uncomplicated urinary tract infection in women. Current practice and the effect of antibiotic resistance on empiric treatment.
OBJECTIVE
To review treatment recommendations for empiric therapy of uncomplicated urinary tract infection (uUTI) in light of evolving antibiotic resistance and to consider use of guidelines to promote optimal practice.


METHODS
PubMed was searched and additional relevant references were identified by reviewing articles found in the search. Guidelines were identified through discussion with family practitioners. Level of evidence was assessed for recommendations.


RESULTS
Many women have uUTIs. The treatment approach is usually empiric antimicrobial therapy without obtaining pretherapy cultures. Trimethoprim-sulfamethoxazole is standard first-line empiric treatment. While resistance to this drug is increasing, it remains only about 10% in community-acquired Escherichia coli in Canada. Concerns about increased resistance have contributed to greater use of fluoroquinolones, but widespread empiric use of this class of medications might promote resistance to fluoroquinolones. Hence, fluoroquinolones should not be considered first-line therapy. While guidelines for treatment of uUTIs have been developed, their usefulness is compromised by their conflicting recommendations.


CONCLUSIONS
Trimethoprim-sulfamethoxazole and nitrofurantoin remain first-choice empiric therapy for uUTIs. Development of guidelines relevant to family physicians and community education programs that incorporate local susceptibility patterns are important strategies for promoting optimal practice.
Nicolle
Lindsay
L
University of Manitoba, Winnipeg. lnicolle@hsc.mb.ca
Anderson
Peter A M
PA
Conly
John
J
Mainprize
Thomas C
TC
Meuser
Jamie
J
Nickel
J Curtis
JC
Senikas
Vyta M
VM
Zhanel
George G
GG
D000892:Anti-Infective Agents, Urinary / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D004338:Drug Combinations; D024881:Drug Resistance, Bacterial; D005260:Female; D024841:Fluoroquinolones / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D009582:Nitrofurantoin / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D013419:Sulfamethizole / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D014295:Trimethoprim / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology; D000096926:Benzenesulfonamides
D000892:Anti-Infective Agents, Urinary; D004338:Drug Combinations; D024841:Fluoroquinolones; D009582:Nitrofurantoin; D013419:Sulfamethizole; D014295:Trimethoprim; C029078:trimethoprim sulfamethizole; D000096926:Benzenesulfonamides