title: Tackling antimicrobial resistance in lower urinary tract infections: treatment options.
abstract: Urinary tract infections (UTIs) are among the most common infectious diseases occurring in either the community or healthcare settings. A wide variety of bacteria are responsible for causing UTIs, however extra-intestinal pathogenic E. coli or ExPEC) remains the most common etiological agent. Since 2000, resistance to antibiotics emerged globally among ExPEC and is causing delays in appropriate therapy with subsequent increased morbidity and mortality.
  
  
  
  The aim of this review article is to provide an overview on the definitions, etiology, treatment guidelines (including agents for infections due to antimicrobial resistant bacteria) of lower UTIs and to highlight recent aspects on antimicrobial resistance of ExPEC. Expert commentary: For patients with acute uncomplicated lower UTIs, nitrofurantoin, trimethoprim-sulfamethoxazole, fosfomycin or pivmecillinam should be prescribed for a 1-5 day course depending on the agent used. Single-dose fosfomycin is an excellent option for uncomplicated lower UTIs and has had similar clinical and/or bacteriological efficacy for 3- or 7-day regimens for alternate agents (i.e., ciprofloxacin, norfloxacin, cotrimoxazole or nitrofurantoin).
authors.affiliation: a Division of Microbiology , Calgary Laboratory Services, University of Calgary , Calgary , Alberta , Canada.|b Department of Pathology and Laboratory Medicine , University of Calgary , Calgary , Alberta , Canada.|c Department of Microbiology, Immunology, and Infectious diseases , University of Calgary , Calgary , Alberta , Canada.|d Snyder Institute for Chronic Diseases , University of Calgary , Calgary , Alberta , Canada.|e Department of Medical Microbiology , University of Pretoria , Pretoria , South Africa.
authors.forename: Johann D
authors.initials: JD
authors.lastname: Pitout
authors.affiliation: a Division of Microbiology , Calgary Laboratory Services, University of Calgary , Calgary , Alberta , Canada.|b Department of Pathology and Laboratory Medicine , University of Calgary , Calgary , Alberta , Canada.
authors.forename: Wilson W
authors.initials: WW
authors.lastname: Chan
authors.affiliation: a Division of Microbiology , Calgary Laboratory Services, University of Calgary , Calgary , Alberta , Canada.|b Department of Pathology and Laboratory Medicine , University of Calgary , Calgary , Alberta , Canada.|e Department of Medical Microbiology , University of Pretoria , Pretoria , South Africa.|f Department of Medicine , University of Calgary , Calgary , Alberta , Canada.
authors.forename: Deirdre L
authors.initials: DL
authors.lastname: Church
mesh_terms: D000892:Anti-Infective Agents, Urinary / Q000008:administration & dosage / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D024881:Drug Resistance, Bacterial / Q000187:drug effects*; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000382:microbiology; D000072282:Extraintestinal Pathogenic Escherichia coli / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D017410:Practice Guidelines as Topic; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000892:Anti-Infective Agents, Urinary
keywords: E. coli ST131; Lower UTIs; antimicrobial resistance; treatment