Antibiotic treatment of uncomplicated urinary tract infection in premenopausal women

Treatment of acute uncomplicated cystitis - A clinical review

“…On the contrary, the infection may cure in 25-42% of women without treatment or inappropriate treatment [1]. However, data do not justify witholding antimicrobial therapy in acute cystitis, because treatment with placebo is associated with prolongation of symptoms as well as a small risk of progression to pyelonephritis [1,6,7,19]. Thus, uncomplicated UTI is one of the most common indications for antimicrobial use in medicine.…”

“…However, it has become apparent that most women with cystitis can be cured with much shorter courses of therapy and, in fact, many with only a single dose of an antimicrobial agent. The advantages of short-course therapy include a lower cost, better compliance, fewer side effects, and perhaps less intensive selective pressure for the emergence of resistant organisms in gut, urethral, or vaginal flora [2,7].…”

“…According to a Cochrane analysis all fluoroquinolones (at comparable dosages) suitable for the treatment of UTI showed the same effectiveness for this indication but tolerability differed [38]. Thus, fluoroquinolones remain very effective for the treatment of acute cystitis, although increased fluoroquinolone resistance among community uropathogens is limiting the usefulness of this antimicrobial class [1][2][3]7,37]. Single-dose fluoroquinolone therapy may be an option for actue uncomplicated cystitis but with possibly lower efficacy rates than with 3-day regimens [1].…”

“…Ampicillin and amoxicillin can no longer be recommended as empirical treatment in acute uncomplicated cystitis given the relatively poor efficacy and the very high prevalence of antimicrobial resistance to these agents worldwide [1][2][3]7].…”

“…The oral cephalosporins of second generation (cefuroxime axetil, cefaclor) have imporved activity against E. coli compared with those of first generation (cepahlexin, cefadroxil), but lower activity compared with those of third generation (cefdinir, cefditoren pivoxil, cefixime, cefpodoxime proxetil and ceftibuten)7. In the ARESC study the overall susceptibility pattern of E.coli and the total of uropathogens for cefuroxime was very similar to that of amoxicillin-clavulanate [4,7,9,10]. Cefdinir, a widely used cephalosporin in United States, is not commercialized in Spain.…”