title: Antibiotic treatment of acute uncomplicated cystitis based on rapid urine test and local epidemiology: lessons from a primary care series.
abstract: BACKGROUND
  Acute uncomplicated cystitis (AUC) is an ideal target of optimization for antibiotic therapy in primary care. Because surveillance networks on urinary tract infections (UTI) mix complicated and uncomplicated UTI, reliable epidemiological data on AUC lack. Whether the antibiotic choice should be guided by a rapid urine test (RUT) for leukocytes and nitrites has not been extensively studied in daily practice. The aim of this primary care study was to investigate local epidemiology and RUT-daily use to determine the optimal strategy.
  
  
  METHODS
  General practitioners included 18-65 years women with symptoms of AUC, performed a RUT and sent urines for analysis at a central laboratory. Different treatment strategies were simulated based on RUT and resistance results.
  
  
  RESULTS
  Among 347 enrolled patients, 78% had a positive urine culture. Escherichia coli predominated (71%) with high rates of susceptibility to nitrofurantoin (100%), fosfomycin (99%), ofloxacin (97%), and even pivmecillinam (87%) and trimethoprim-sulfamethoxazole (87%). Modelization showed that the systematic use of RUT would reduce by 10% the number of patients treated. Fosfomycin for patients with positive RUT offered a 90% overall bacterial coverage, compared to 98% for nitrofurantoin. 95% for ofloxacin, 86% for trimethoprim-sulfamethoxazole and 78% for pivmecillinam.
  
  
  CONCLUSIONS
  Local epidemiology surveillance data not biased by complicated UTI demonstrates that the worldwide increase in antibiotic resistance has not affected AUC yet. Fosfomycin first line in all patients with positive RUT seems the best treatment strategy for AUC, combining good bacterial coverage with expected low toxicity and limited effect on fecal flora.
  
  
  BACKGROUND
  The current study was registered at clinicaltrials.gov (NCT00958295).
authors.affiliation: Infectious diseases, Rouen University Hospital, rue de Germont, Rouen F-76031, France. manuel.etienne@chu-rouen.fr.
authors.forename: Manuel
authors.initials: M
authors.lastname: Etienne
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Lefebvre
authors.forename: Noëlle
authors.initials: N
authors.lastname: Frebourg
authors.forename: Hélène
authors.initials: H
authors.lastname: Hamel
authors.forename: Martine
authors.initials: M
authors.lastname: Pestel-Caron
authors.forename: François
authors.initials: F
authors.lastname: Caron
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003556:Cystitis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology / Q000652:urine*; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000652:urine; D005260:Female; D006801:Humans; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data; D016482:Urinalysis; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology / Q000652:urine*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents