Jennifer Kranz1,2, Stefanie Schmidt2, Cordula Lebert3, Laila Schneidewind2,4, Falitsa Mandraka5, Mirjam Kunze6, Sina Helbig7, Winfried Vahlensieck8, Kurt Naber9, Guido Schmiemann10, Florian M Wagenlehner11. 1. Department of Urology and Paediatric Urology, St. Antonius Hospital, Eschweiler, Germany. 2. UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany. 3. Pharmacy, Klinikum Nürnberg, Nürnberg, Germany. 4. Klinik für Innere Medizin C, Hämatologie/Onkologie, Universitätsmedizin Greifswald, Greifswald, Germany. 5. Department of Obstetrics and Gynecology, Medical Center, University of Freiburg, Freiburg, Germany. 6. Department of Infectious Diseases, Laboratory Dr. Wisplinghoff, Cologne, Germany. 7. Division of Infectious Diseases, University Hospital Carl Gustav Carus, Dresden, Germany. 8. Department of Urology, Kurpark-Klinik, Bad Nauheim, Germany. 9. Technical University of Munich, Munich, Germany. 10. Department for Health Services, Research Institute for Public Health and Nursing Science, Bremen University, Bremen, Germany. 11. Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany.
Abstract
BACKGROUND: We aimed to update the 2010 evidence- and consensus-based national clinical guideline on the diagnosis and management of uncomplicated urinary tract infections (UTIs) in adult patients. Results are published in 2 parts. Part 1 covers methods, the definition of patient groups, and diagnostics. This second publication focuses on treatment of acute episodes of cystitis and pyelonephritis as well as on prophylaxis of recurrent UTIs. MATERIALS AND METHODS: An interdisciplinary group consisting of 17 representatives of 12 medical societies and a patient representative was formed. Systematic literature searches were conducted in MEDLINE, EMBASE, and the Cochrane Library to identify literature published in 2010-2015. RESULTS: For the treatment of acute uncomplicated cystitis (AUC), fosfomycin-trometamol, nitrofurantoin, nitroxoline, pivmecillinam, and trimethoprim (depending on the local rate of resistance) are all equally recommended. Cotrimoxazole, fluoroquinolones, and cephalosporins are not recommended as antibiotics of first choice, for concern of an unfavorable impact on the microbiome. Mild to moderate uncomplicated pyelonephritis should be treated with oral cefpodoxime, ceftibuten, ciprofloxacin, or levofloxacin. For AUC with mild to moderate symptoms, instead of antibiotics symptomatic treatment alone may be considered depending on patient preference after discussing adverse events and outcomes. Primarily non-antibiotic options are recommended for prophylaxis of recurrent urinary tract infection. CONCLUSION: In accordance with the global antibiotic stewardship initiative and considering new insights in scientific research, we updated our German clinical UTI guideline to promote a responsible antibiotic use and to give clear hands-on recommendations for the diagnosis and management of UTIs in adults in Germany for healthcare providers and patients.
BACKGROUND: We aimed to update the 2010 evidence- and consensus-based national clinical guideline on the diagnosis and management of uncomplicated urinary tract infections (UTIs) in adult patients. Results are published in 2 parts. Part 1 covers methods, the definition of patient groups, and diagnostics. This second publication focuses on treatment of acute episodes of cystitis and pyelonephritis as well as on prophylaxis of recurrent UTIs. MATERIALS AND METHODS: An interdisciplinary group consisting of 17 representatives of 12 medical societies and a patient representative was formed. Systematic literature searches were conducted in MEDLINE, EMBASE, and the Cochrane Library to identify literature published in 2010-2015. RESULTS: For the treatment of acute uncomplicated cystitis (AUC), fosfomycin-trometamol, nitrofurantoin, nitroxoline, pivmecillinam, and trimethoprim (depending on the local rate of resistance) are all equally recommended. Cotrimoxazole, fluoroquinolones, and cephalosporins are not recommended as antibiotics of first choice, for concern of an unfavorable impact on the microbiome. Mild to moderate uncomplicated pyelonephritis should be treated with oral cefpodoxime, ceftibuten, ciprofloxacin, or levofloxacin. For AUC with mild to moderate symptoms, instead of antibiotics symptomatic treatment alone may be considered depending on patient preference after discussing adverse events and outcomes. Primarily non-antibiotic options are recommended for prophylaxis of recurrent urinary tract infection. CONCLUSION: In accordance with the global antibiotic stewardship initiative and considering new insights in scientific research, we updated our German clinical UTI guideline to promote a responsible antibiotic use and to give clear hands-on recommendations for the diagnosis and management of UTIs in adults in Germany for healthcare providers and patients.
Authors: Florian M E Wagenlehner; Truls E Bjerklund Johansen; Tommaso Cai; Bela Koves; Jennifer Kranz; Adrian Pilatz; Zafer Tandogdu Journal: Nat Rev Urol Date: 2020-08-25 Impact factor: 14.432