Antibiotic resistance in community-acquired urinary tract infections.

We studied the antibiotic susceptibility of midstream urine isolates from patients with community-acquired urinary tract infections at Groote Schuur Hospital from 1986 to 1991. The majority of the isolates was resistant to amoxycillin and co-trimoxazole, and the proportion of resistant Escherichia coli isolates increased during the study period. In a prospective 4-month study in 1991 we found that the vast majority of isolates was susceptible to aminoglycosides, amoxycillin/clavulanate, second-generation cephalosporins and the new fluoroquinolones. Based on these findings amoxycillin and co-trimoxazole should no longer be prescribed for urinary tract infections unless a susceptible isolate has been cultured. Appropriate empirical oral agents are expensive and not generally available in the public sector. There is an urgent need to make these agents available in the public sector, but their use should be restricted as widespread use for the treatment of other infections would inevitably lead to the development of resistance.