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Antibiotic treatment of acute uncomplicated cystitis based on rapid urine test and local epidemiology: lessons from a primary care series
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Antibiotic treatment of acute uncomplicated cystitis based on rapid urine test and local epidemiology: lessons from a primary care series
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Journal Article
Antibiotic treatment of acute uncomplicated cystitis based on rapid urine test and local epidemiology: lessons from a primary care series
2014
Overview
Background
Acute uncomplicated cystitis (AUC) is an ideal target of optimization for antibiotic therapy in primary care. Because surveillance networks on urinary tract infections (UTI) mix complicated and uncomplicated UTI, reliable epidemiological data on AUC lack. Whether the antibiotic choice should be guided by a rapid urine test (RUT) for leukocytes and nitrites has not been extensively studied in daily practice. The aim of this primary care study was to investigate local epidemiology and RUT-daily use to determine the optimal strategy.
Methods
General practitioners included 18–65 years women with symptoms of AUC, performed a RUT and sent urines for analysis at a central laboratory. Different treatment strategies were simulated based on RUT and resistance results.
Results
Among 347 enrolled patients, 78% had a positive urine culture.
Escherichia coli
predominated (71%) with high rates of susceptibility to nitrofurantoin (100%), fosfomycin (99%), ofloxacin (97%), and even pivmecillinam (87%) and trimethoprim-sulfamethoxazole (87%). Modelization showed that the systematic use of RUT would reduce by 10% the number of patients treated. Fosfomycin for patients with positive RUT offered a 90% overall bacterial coverage, compared to 98% for nitrofurantoin. 95% for ofloxacin, 86% for trimethoprim-sulfamethoxazole and 78% for pivmecillinam.
Conclusion
Local epidemiology surveillance data not biased by complicated UTI demonstrates that the worldwide increase in antibiotic resistance has not affected AUC yet. Fosfomycin first line in all patients with positive RUT seems the best treatment strategy for AUC, combining good bacterial coverage with expected low toxicity and limited effect on fecal flora.
Trial registration
The current study was registered at clinicaltrials.gov (
NCT00958295
)
Publisher
BioMed Central,BioMed Central Ltd
Subject
/ Adult
/ Analysis
/ Anti-Bacterial Agents - therapeutic use
/ Bacterial and fungal diseases
/ Drug resistance in microorganisms
/ Escherichia coli - drug effects
/ Escherichia coli - isolation & purification
/ Escherichia coli Infections - drug therapy
/ Escherichia coli Infections - epidemiology
/ Escherichia coli Infections - microbiology
/ Escherichia coli Infections - urine
/ Female
/ Humans
/ Medicine
/ Primary Health Care - statistics & numerical data
/ Urinary Tract Infections - drug therapy
/ Urinary Tract Infections - epidemiology
/ Urinary Tract Infections - microbiology
