title: Uncomplicated urinary tract infection in women. Current practice and the effect of antibiotic resistance on empiric treatment.
abstract: 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.
authors.affiliation: University of Manitoba, Winnipeg. lnicolle@hsc.mb.ca
authors.forename: Lindsay
authors.initials: L
authors.lastname: Nicolle
authors.forename: Peter A M
authors.initials: PA
authors.lastname: Anderson
authors.forename: John
authors.initials: J
authors.lastname: Conly
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Mainprize
authors.forename: Jamie
authors.initials: J
authors.lastname: Meuser
authors.forename: J Curtis
authors.initials: JC
authors.lastname: Nickel
authors.forename: Vyta M
authors.initials: VM
authors.lastname: Senikas
authors.forename: George G
authors.initials: GG
authors.lastname: Zhanel
mesh_terms: 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
chemical_list: D000892:Anti-Infective Agents, Urinary; D004338:Drug Combinations; D024841:Fluoroquinolones; D009582:Nitrofurantoin; D013419:Sulfamethizole; D014295:Trimethoprim; C029078:trimethoprim sulfamethizole; D000096926:Benzenesulfonamides