[Treatment of uncomplicated lower urinary tract infections]

Author(s): Horcajada JP, Garcia-Palomo D, Farinas MC

Affiliation(s): Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario Marques de Valdecilla, Universidad de Cantabria, Santander, Espana. jhorcajada@yahoo.es

Publication date & source: 2005-12, Enferm Infecc Microbiol Clin., 23 Suppl 4:22-7.

Publication type: Review

Empirical antibiotic treatment of lower urinary tract infections should be based on the patient's clinical data and on local sensitivity data. Because of the increase in resistance among uropathogens, recommendations on the empirical treatment of urinary tract infections have been modified. Currently, the empirical use of co-trimoxazole, ampicillin, and first-generation cephalosporins and quinolones is not recommended. Fluoroquinolones have been demonstrated to be highly effective in comparative studies but, because of the increase in resistance, the type of patient who can benefit from these antimicrobial agents must be selected. Second- and third-generation cephalosporins still have high sensitivity rates, although the higher recurrence rates associated with their use and the emergence of extended-spectrum beta-lactamase-producing enterobacterial in the community should be taken into account. Amoxicillin-clavulanate is less effective in eradicating infections than quinolones. Fosfomycin-trometamol has resistance rates of below 2% and single-dose therapy has been demonstrated to be safe and effective. Nitrofurantoin is also currently active, although it must be administered for 7 days and can produce toxicity. Both agents are currently recommended as alternative therapeutic options to fluoroquinolones in uncomplicated infections of the lower urinary tract.