Lack of uniformity among United States recommendations for diagnosis and management of acute, uncomplicated cystitis

Markowitz, Melissa; Wood, Lauren N.; Raz, Shlomo; Miller, Loren G.; Haake, David A.; Kim, Ja-Hong

doi:10.1007/s00192-018-3750-z

Cited by 16 publications

(9 citation statements)

References 30 publications

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“…Primary care physicians increasingly have multiple and sometimes conflicting guidelines [39] for patient care and are challenged to maintain the knowledge base represented by the array of guidelines for common problems. In a nationally representative sample of family physicians, Wolff and colleagues [40] found that time constraints, concern for patient well-being, and consideration of particular circumstances were all potential obstacles to guideline adherence; such concerns (e.g., compliance concerns, patient preferences, and previously reported side effects) were noted by the physicians interviewed for the current study.…”

Section: Discussionmentioning

confidence: 99%

Qualitative Analysis of Primary Care Provider Prescribing Decisions for Urinary Tract Infections

et al. 2019

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Inappropriate choices and durations of therapy for urinary tract infections (UTI) are a common and widespread problem. In this qualitative study, we sought to understand why primary care providers (PCPs) choose certain antibiotics or durations of treatment and the sources of information they rely upon to guide antibiotic-prescribing decisions. We conducted semi-structured interviews with 18 PCPs in two family medicine clinics focused on antibiotic-prescribing decisions for UTIs. Our interview guide focused on awareness and familiarity with guidelines (knowledge), acceptance and outcome expectancy (attitudes), and external barriers. We followed a six-phase approach to thematic analysis, finding that many PCPs believe that fluoroquinolones achieve more a rapid and effective control of UTI symptoms than trimethoprim-sulfamethoxazole or nitrofurantoin. Most providers were unfamiliar with fosfomycin as a possible first-line agent for the treatment of acute cystitis. PCPs may be misled by advanced patient age, diabetes, and recurrent UTIs to make inappropriate choices for the treatment of acute cystitis. For support in clinical decision making, few providers relied on guidelines, preferring instead to have decision support embedded in the electronic medical record. Knowing the PCPs’ knowledge gaps and preferred sources of information will guide the development of a primary care-specific antibiotic stewardship intervention for acute cystitis.

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Section: Discussionmentioning

confidence: 99%

Qualitative Analysis of Primary Care Provider Prescribing Decisions for Urinary Tract Infections

et al. 2019

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“…It is a pathogenic inflammation of the lower urinary tract. Women are more commonly afflicted with UTIs, and they are caused by common pathogens such as Escherichia coli (86%) [26]. Uropathogenic Escherichia coli (UPEC) is significantly associated with cystitis via sets of virulence factors (adhesins, siderophores, toxins, capsule production and protease) that assist its colonization, invasion, and survival within the host urinary system [27,28].…”

Section: Expec-associated Cystitis and Antibiotic Resistancementioning

confidence: 99%

Antibiotic Resistance among Iraqi LocalE. coliIsolates

Al-Dahmoshi¹,

Al-Khafaji²,

Al-Allak³

2020

E. Coli Infections - Importance of Early Diagnosis and Efficient Treatment

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Escherichia coli is a famous Gram-negative bacillary bacterium that belongs to Enterobacteriaceae. It is either micro-biota innocent for human or pathogenic with arrays of diseases. The pathogenic E. coli can be assigned to intestinal (InPEC) or extraintestinal (ExPEC) with disease ranging from watery diarrhea to pulmonary distress. The most prevalent form of InPEC is enteropathogenic E. coli (EPEC), while the most prevalent ExPEC is uropathogenic E. coli (UPEC). The other InPEC includes Shiga toxin-producing (STEC), enteroaggregative (EAEC), enterotoxigenic (ETEC), enteroinvasive (EIEC), diffusely adherent (DAEC) and adherent invasive E. coli (AIEC). ExPEC was implicated in cystitis, pyelonephritis, sepsis, respiratory tract infection, cervicovaginal infection (CVEC), meningitis (NMEC), otitis media, cholecystitis and wound infection. Antibiotic resistance is the challenging in world nowadays. Multidrug-resistant (MDR) Escherichia coli has become challenging with existing antibiotic options. E. coli pathogens have various virulence factors that determine their pathogenesis and antimicrobial resistance mechanisms. The rapid and ongoing spread of antimicrobial-resistant organisms threatens our ability to successfully treat a growing number of infectious diseases. It is well established that antibiotic use is a significant, and modifiable, driver of antibiotic resistance. The most commonly used antibiotic classes for InPEC and ExPEC were third-generation cephalosporin, carbapenem, fluoroquinolone and aminoglycosides. Actually, the most effective prescribed medication is one of the following: cefotaxime, ceftriaxone, ciprofloxacin, amikacin, gentamycin, levofloxacin and imipenem. Generally, according to our review for more than 100 local Iraqi studies among Iraqi provinces, the results revealed the resistance rate from highest to lowest as follows: cefotaxime (76.5%), ceftriaxone (75.9%), gentamycin (41.65%), ciprofloxacin (32.13%), amikacin (17.3%), levofloxacin (15%) and imipenem (5.14%). The resistance mechanisms may include genes encoding antibiotic-modifying enzymes like those of extended-spectrum beta-lactamases gene comprising: blaCTX-M, blaTEM, blaSHV, blaOXA, blaPER, blaVIM, blaIMP, blaNDM and blaAMPc. Efflux pumping includes AcrAB, while resistance to quinolone may be mediated by mutation among qnrA, qnrB, qnrD and qnrS. Resistance to aminoglycosides includes encoding to aminoglycosidemodifying enzymes like aac(6)-Ib, aph(3)-I, aph(3)-IIa, aph(3)-Ib, ant(3)-I, aac(3)-II and aac(3)-IV.

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“…This economical concern also supports the introduction of relatively narrow-spectrum antibiotics in patients with AUC in the long run. In fact, the Infectious Diseases Society of America (IDSA) weighted risk for MDR than antimicrobial efficacy in the treatment for AUC, taking into account not only mere individual short-term benefit, but also including economic status of the society [28].…”

Section: Resultsmentioning

confidence: 99%

Cefaclor as a first-line treatment for acute uncomplicated cystitis

Koguchi¹,

Murakami²,

Ikeda³

et al. 2020

Preprint

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Background: Wide-spectrum antibiotics have been favored to treat acute uncomplicated cystitis (AUC) for a long time, leading to the emergence of multi-drug resistant bacteria. We hypothesize that narrow-spectrum antibiotics might mitigate the issue and aim to investigate the clinical efficacy of cefaclor in patients with AUC.Methods: We retrospectively reviewed the clinical data of female outpatients with AUC treated with cefaclor and evaluated the safety and clinical efficacy. Clinical cure was defined as the elimination of clinical symptom under 4 white blood cells (WBCs) per high power field on microscopy.Results: Overall, 223 women with AUC were enrolled. Escherichia coli was the dominant pathogen (n=160; 68.6%), followed by Klebsiella species and E. coli-extended spectrum β-lactamase (ESBL) (n=19; 8.1% and n=18; 7.7%). Overall success rate was 94.0% (n=219) and susceptibility rate of cefazolin was 84.1%, which was close to that of levofloxacin (82.9%). Ampicillin showed the lowest rate of 63.7% with a significantly greater resistance rate of 35.3% among all antibiotics (P<0.001). In the subgroup analysis, the success rate in patients with resistance to levofloxacin or cefazolin was 100% (n=24) or 93.3% (n=14). The rate in patients with resistance to both antibiotics was 60.0% (n=9), and the pathogens in the other 40.0% (n=6) of patients with treatment failure were E. coli-ESBL.Conclusion: Cefaclor showed an excellent efficacy in AUC patients, even in those with resistance to cefazolin or levofloxacin. Cefaclor has the potential to be the first-line and second-line therapies for patients with levofloxacin treatment failure.

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Lack of uniformity among United States recommendations for diagnosis and management of acute, uncomplicated cystitis

Cited by 16 publications

References 30 publications

Qualitative Analysis of Primary Care Provider Prescribing Decisions for Urinary Tract Infections

Qualitative Analysis of Primary Care Provider Prescribing Decisions for Urinary Tract Infections

Antibiotic Resistance among Iraqi LocalE. coliIsolates

Cefaclor as a first-line treatment for acute uncomplicated cystitis

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