Guidelines, evidence, and cultural factorsComparison of four European guidelines on uncomplicated cystitis

Abstract

There are substantial differences even between high-standard guidelines on the same well-defined clinical entity. The selection of literature data, and diagnostic and therapeutic recommendations, seemed to be influenced by such cultural aspects as habits, the patient's expectations, and the structure of the healthcare system.

Antimicrobial susceptibility of Escherichia coli from community-acquired urinary tract infections in Europe: the ECO·SENS study revisited

“…Table 2 shows the geographical distribution of antimicrobial resistance in 903 E. coli isolates from ECO·SENS Table 2 Resistance rates amongst Escherichia coli from urinary tract infections in five European countries in 2008 (ECO·SENS II) compared with resistance rate in the first ECO·SENS study in 2000 [5,6]. 16.0% in Portugal). The mean level of resistance to the other agents tested was <5% and was <2% for mecillinam, nitrofurantoin, fosfomycin trometamol, gentamicin and oral thirdgeneration cephalosporins.…”

“…Trimethoprim is recommended as the empirical treatment of choice for uncomplicated UTIs in several European countries [16]. In our opinion, increasing resistance and the fact that it co-selects for fluoroquinolone resistance makes it unsuitable as a first-line empirical choice in community-acquired UTIs.…”

Clinical and bacteriological outcome of different doses and duration of pivmecillinam compared with placebo therapy of uncomplicated lower urinary tract infection in women: The LUTIW project

“…In order to prevent unnecessary consumption of antibiotics we consider that antibiotics should be prescribed for symptomatic bacteriuria and not for symptoms only, and therefore we focus outcome of therapy on Table III patients with significant bacteriuria. This is supported by Belgian, Dutch, and German guidelines [23], which advise both symptoms and urinalysis for diagnosis and therapy of UTI, but is opposed by Norwegian guidelines [24], which recommend empirical therapy for symptoms only. This also contradicts the increasing tendency in clinical practice to prescribe antibiotics for symptoms only, which has been reported to be cost-effective [25] and has been proposed in the US [26].…”

Differences Among International Pharyngitis Guidelines: Not Just Academic

“…[2][3][4] Several authors, however, have pointed to differences that could be explained by insuffi cient evidence, different interpretations of the evidence, unsystematic guideline development methods, the infl uence of professional bodies, patient preferences, cultural and socioeconomic factors, or characteristics of health care systems. [5][6][7][8][9][10][11][12][13][14][15][16][17][18] Three studies explored differences of content in relation to differences of the cited scientifi c evidence supporting the recommendations. [7][8][9] Selective use of evidence can lead to differences in practice recommendations and, consequently, to important disparities in patient care and outcome.…”