Antibiotic treatment of acute uncomplicated cystitis based on rapid urine test and local epidemiology: lessons from a primary care series

Abstract

BackgroundAcute 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.MethodsGeneral 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.ResultsAmong 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.ConclusionLocal 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 registrationThe current study was registered at clinicaltrials.gov (NCT00958295)

Risk factors for resistance in urinary tract infections in women in general practice: A cross-sectional survey

“…25,26 For fluoroquinolone, we also observed a susceptibility rate of 98%, while the latest published studies in France reported rates of 89%e97%. 25,26 In the study with the lowest susceptibility rate estimates, data had been transmitted by a laboratory network based on urine collected mostly for complicated UTIs, thus resulting in higher resistance rates than observed in the general population. ESBLE represented 1.6% of our sample, which is within the range of the most recently published studies, i.e., 0e3% of UTIs.…”

Plasmidic qnr Genes Confer Clinical Resistance to Ciprofloxacin under Urinary Tract Physiological Conditions

“…luoroquinolones (FQs) are broad-spectrum antibiotics commonly used for urinary tract infection (UTI) (1)(2)(3). However, in recent years, a worrisome increase in resistance to FQs has been addressed worldwide (4,5).…”

Urinary Tract Physiological Conditions Promote Ciprofloxacin Resistance in Low-Level-Quinolone-Resistant Escherichia coli

“…iprofloxacin (CIP) is one of the agents commonly utilized for treatment of urinary tract infections (UTIs) (1)(2)(3). It is used as an appropriate therapy in patients with UTI not requiring hospitalization in areas where the prevalence of resistance is under 10%.…”