Abstract
The Infectious Diseases Society of America has published guidelines for the treatment of uncomplicated cystitis. Recommendations are that for healthy, adult, nonpregnant women with bacterial cystitis, 3 days of trimethoprim/ sulfamethoxazole (TMP/SMZ) or trimethoprim alone is standard therapy in those regions where less than 10% to 20% of Escherichia coli that cause such infections is resistant to TMP/SMZ. In those regions where resistance is more than 10% to 20%, the committee recommended using an oral fluoroquinolone for 3 days, and that alternatives such as nitrofurantoin for 7 days or fosfomycin as single-dose therapy need more study. These recommendations were established in the late 1990s as resistance to TMP/SMZ among uropathogens was increasing in the United States, a phenomenon earlier observed in other parts of the world. Clinicians should be alert to patients infected with possibly resistant organisms, eg, patients who have recently been hospitalized or are receiving antibiotics.
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References and Recommended Reading
US Department of Health and Human Services, Public Health Service, National Institutes of Health: The National Kidney and Urologic Diseases Advisory Board 1990 Long-Range Plan-Window on the 21st Century. Bethesda, MD: National Institutes of Health; NIH publication no. 90-583; 1990.
Patton JP, Nash DB, Abrutyn E: Urinary tract infection: economic considerations. Med Clin North Am 1991, 75:495–513.
Kunin CM: Urinary tract infections. Flow charts (algorithms) for detection and treatment. JAMA 1975, 233:458–462.
Berg AO: Variations among family physicians’ management strategies for lower urinary tract infection in women: a report from the Washington Family Physicians Collaborative Research Network. J Am Board Fam Pract 1991, 4:327–330.
Wigton RS, Longenecker JC, Bryan TJ, et al.: Variation by specialty in the treatment of urinary tract infection in women. J Gen Intern Med 1999, 14:491–494.
Barry HC, Ebell MH, Hickner J: Evaluation of suspected urinary tract infection in ambulatory women: a cost-utility analysis of office-based strategies. J Fam Pract 1997, 44:49–60.
Warren JW, Abrutyn E, Hebel JR, et al.: Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Clin Infect Dis 1999, 29:745–758. This is a systematic review of the copious literature reporting randomized controlled trials of treatment of uncomplicated UTIs.
1996 ASCP Susceptibility Testing Group: United States geographic bacteria susceptibility patterns. Am J Clin Pathol 1998, 109: 144–152.
Jones RN, Kugler KC, Pfaller MA, et al.: Characteristics of pathogens causing urinary tract infections in hospitals in North America: results from the SENTRY Antimicrobial Surveillance Program, 1997. Diagn Microbiol Infect Dis 1999, 35:55–63.
Dyer IE, Sankary TM, Dawson JA: Antibiotic resistance in bacterial urinary tract infections, 1991 to 1997. West J Med 1998, 169:265–268.
Gupta K, Scholes D, Stamm WE: Increasing prevalence of antimicrobial resistance among uropathogens causing acute uncomplicated cystitis in women. JAMA 1999, 281:736–738. In a retrospective review in an HMO, these authors documented a progressive rise in resistance to TMP/SMZ, from 8% in 1992 to 16% in 1996; resistance to nitrofurantoin and to ciprofloxacin remained at less than 2%.
Zhanel GG, Karlowsky JA, Harding GKM, et al.: A Canadian national surveillance study of urinary tract isolates from outpatients: comparison of the activities of trimethoprim-sulfamethoxazole, ampicillin, mecillinam, nitrofurantoin, and ciprofloxacin. Antimicrob Agents Chemother 2000, 44:1089–1092.
Talan DA, Stamm WE, Hooton TM, et al.: Comparison of ciprofloxacin (7 days) and trimethoprim-sulfamethoxazole (14 days) for acute uncomplicated pyelonephritis in women. A randomized trial. JAMA 2000, 283:1583–1590.
McCarty JM, Richard G, Huck W, et al.: A randomized trial of ciprofloxacin, ofloxacin, or trimethoprim/sulfamethoxazole for the treatment of acute urinary tract infection in women. Am J Med 1999, 106:292–299.
Wright SW, Wrenn KD, Haynes ML: Trimethoprim-sul-famethoxazole resistance among urinary coliform isolates. J Gen Intern Med 1999, 14:606–609. This is a retrospective case control study seeking risk factors for TMP/ SMZ resistance among patients with UTIs (cystitis and, apparently, acute pyelonephritis) and identified diabetes, recent hospitalization, and the use of antibiotics (particularly TMP/SMZ) as independent risk factors.
Ena J, Amador C, Martinez C, de la Tabla VO: Risk factors for acquisition of urinary tract infections caused by ciprofloxacin resistant Escherichia coli. J Urol 1995, 153:117–120. This case control study from Spain examines ciprofloxacin resistance causing UTIs in hospitalized patients and, using a multivariate analysis, found that risk factors were, first of all, previous use of quinolones, then urologic abnormalities, age 65 years or older, and use of a urinary catheter.
Saint S, Scholes D, Fihn SD, et al.: The effectiveness of a clinical practice guideline for the management of presumed uncomplicated urinary tract infection in women. Am J Med 1999, 106:363–641.
O’Connor PJ, Solberg LI, Christianson J, et al.: Mechanism of action and impact of a cystitis clinical practice guideline on outcomes and costs of care in an HMO. Jt Comm J Qual Improv 1996, 22:673–682.
Hirst GHL, Ward JE: Clinical practice guidelines: reality bites. Med J Aust 2000, 172:287–291.
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Warren, J.W. Practice guidelines for the treatment of uncomplicated cystitis. Curr Urol Rep 2, 326–329 (2001). https://doi.org/10.1007/s11934-001-0072-2
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DOI: https://doi.org/10.1007/s11934-001-0072-2