Update: Rational antibiotic treatment of outpatient genitourinary infections in a changing environment

Article Sidebar

28-May-2119.pdf
Published Jun 18, 2020
DOI: https://doi.org/10.18103/mra.v8i6.2119

Downloads

Download data is not yet available.

Main Article Content

Joshua A. Sherman
Advocate Christ Medical Center, Oak Lawn, Illinois, USA
Peter M.C. DeBlieux
Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA

Abstract

Urinary tract infections (UTIs) are the most common bacterial infections presenting in the outpatient setting.  Choosing the right empiric treatment for genitourinary infections continues to become more difficult due to increases in antimicrobial resistance, shifting and unpredictable regional resistance patterns, and changing etiologies.  Even uncomplicated, community-acquired urinary tract infections generally considered easy to treat, are posing therapeutic challenges.  UTIs are classified as uncomplicated or complicated. Uncomplicated UTIs occur in sexually active healthy female patients with structurally and functionally normal urinary tracts. Complicated UTIs are those that are associated with structural anatomic abnormalities or comorbid conditions that prolong the need for treatment, increasing the chances for therapeutic failure.   All UTIs in male patients are considered complicated as are those that occur in the setting of pregnancy, chemotherapy and/or other immunosuppression.  Escherichia coli is generally considered the most common cause of UTI--especially in uncomplicated, community-acquired infections – accounting for 75-95%.  Alleviation of symptoms and prevention of complications are short-term treatment goals for UTIs.   Long-term goals include prevention of recurrent infection and improvement in rate of reinfection.  The Infectious Disease Society of America guidelines currently recommend Nitrofurantoin as first-line therapy for uncomplicated UTIs when local uropathogen resistance to TMP-SMX exceeds 20%, an increasingly common occurrence that underscores the need for clinicians to be aware of resistance patterns in their community.  Alternatively, where available and cost-efficient, Fosfomycin or Pivmecillinam should be considered prior to alternative antimicrobial therapy in the form of either fluoroquinolones or beta-lactams.  The best approach for treating outpatient UTIs focuses on adapting antimicrobial therapy to rapidly changing bacterial resistance patterns.

Article Details

How to Cite
SHERMAN, Joshua A.; DEBLIEUX, Peter M.C.. Update: Rational antibiotic treatment of outpatient genitourinary infections in a changing environment. Medical Research Archives, [S.l.], v. 8, n. 6, june 2020. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2119>. Date accessed: 20 apr. 2024. doi: https://doi.org/10.18103/mra.v8i6.2119.
ABNT APA BibTeX CBE EndNote - EndNote format (Macintosh & Windows) MLA ProCite - RIS format (Macintosh & Windows) RefWorks Reference Manager - RIS format (Windows only) Turabian
Issue
Vol 8 No 6 (2020): Vol.8 Issue 6 June, 2020
Section
Research Articles

The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.

 

References

1. Gupta K, Hooton TM, Stamm WE. Increasing antimicrobial resistance and the management of uncomplicated community-acquired urinary tract infections. Ann Intern Med. 2001;135:41–50.
2. Foxman B. Epidemiology of urinary tract infections: incidence, mor- bidity, and economic costs. Am J Med. 2002;113(suppl):5S–13S.
3. Foxman B. Epidemiology of urinary tract infections: incidence, mor- bidity, and economic costs. Dis Mon. 2003;49:53–70.
4. Warren JW, Abrutyn E, Hebel JR, Johnson JR, Schaeffer AJ, Stamm WE. Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Clin Infect Dis. 1999;29:745–758.
5. Hooton TM. Pathogenesis of urinary tract infections: an update. J Antimicrob Chemother. 2000;46:1–7.
6. Stapleton AE. Urinary tract infections in healthy women. Curr Treat Opt Infect Dis. 2003;5:43–51.
7. Schaeffer AJ. Diagnosis and management of prostatitis. Brazilian Journal of Urology 2000;26:122–131.
8. Nicolle LE. Epidemiology of urinary tract infection. Infect Med. 2001; 18:153–162.
9. Hooton TM, Stamm WE. Diagnosis and treatment of uncomplicated urinary tract infection. Infect Dis Clin North Am. 1997;11:551–581.
10. Clinical Effectiveness Group (Association of Genitourinary Medicine and the Medical Society for the Study of Venereal Diseases). National guideline for the management of prostatitis. Sex Transm Infect. 1999; 75(suppl 1):S46 –S50.
11. Jack GS, Zeitlin SI. Confronting prostatitis: is your management strat- egy up-to-date? Contemp Urol. 2004;16:34 – 46.
12. McCue J. UTIs in at-risk patients: are they complicated? Infect Med.
1999;16:533–540.
13. Bundrick W, Heron SP, Ray P, et al. Levofloxacin versus ciprofloxacin in the treatment of chronic bacterial prostatitis: a randomized double- blind multicenter study. Urology. 2003;62:537–541.
14. Trovan® (trovafloxacin) New Drug Application. US Food and Drug Administration Web site. Available at: http://www.fda.gov/cder/foi/ nda/97/020760a_medr_P6.pdf. Accessed October 13, 2004.
15. Dow G, Rao P, Harding G, et al. A prospective, randomized trial of 3 of 14 days of ciprofloxacin treatment for acute urinary tract infection in patients with spinal cord injury. Clin Infect Dis. 2004;39:658 – 664.
16. Nicolle L. Best pharmacological practice: urinary tract infections. Expert Opin Pharmacother. 2003;4:693–704.
17. Naber KG. Short-term therapy of acute uncomplicated cystitis. Curr Opin Urol. 1999;9:57– 64.
18. Gilbert DN, Moellering RC Jr, Eliopoulos GM, Sande MA. The San- ford Guide to Antimicrobial Therapy, 34th ed. Hyde Park, VT: Anti- microbial Therapy, Inc., 2004.
19. Data on file. The Surveillance Network (TSN) Database 2003. Raritan, NJ: Ortho-McNeil Pharmaceutical, Inc., 2003.
20. Stamm WE, Norrby SR. Urinary tract infections: disease panorama and challenges. J Infect Dis 2001;183(suppl 1):S1–S4.
21. Nicolle LE. Urinary tract infection: traditional pharmacologic thera- pies. Am J Med 2002;113(suppl 1A):35S– 44S.
22. Gupta K, Sahm DF, Mayfield D, Stamm WE. Antimicrobial resistance among uropathogens that cause community-acquired urinary tract in- fections in women: a nationwide analysis. Clin Infect Dis. 2001;33: 89 –94.
23. Lummus WE, Thompson I. Prostatitis. Emerg Med Clin North Am. 2001;19:691–707.
24. Fowler JE Jr. Antimicrobial therapy for bacterial and nonbacterial prostatitis. Urology. 2002;60:24 –26.
25. Zhanel GG, Ennis K, Vercaigne L, et al. A critical review of the fluoroquinolones: focus on respiratory infections. Drugs. 2002;62:13– 59.
26. Drusano GL, Preston SL, Van Guilder M, et al. A population phar- macokinetic analysis of the penetration of the prostate by levofloxacin. Antimicrob Agents Chemother. 2000;44:2046 –2051.
27. Nicolau D. Clinical and economic implications of antimicrobial resis- tance for the management of community-acquired respiratory tract infections. J Antimicrob Chemother 2002;50(suppl S1):61–70.
28. Giblin TB, Sinkowitz-Cochran RL, Harris PL, et al, for the CDC Campaign to Prevent Antimicrobial Resistance Team. Clinicians’ per- ceptions of the problem of antimicrobial resistance in health care facilities. Arch Intern Med. 2004;164:1662–1668.
29. Talan DA, Stamm WE, Hooton TM, et al. Comparison of ciprofloxacin (7 days) and trimethoprim-sulfamethoxazole (14 days) for acute un- complicated pyelonephritis in women: a randomized trial. JAMA. 2000;283:1583–1590.
30. Data on file. Proceedings of the TRUST 8 (2004) Investigators’ Meet- ing; May 25, 2004; New Orleans, LA. Raritan, NJ: Ortho-McNeil Pharmaceutical, Inc., 2004.
31. Data on file. Proceedings of the TRUST 7 (2002-2003) Surveillance Study. Raritan, NJ: Ortho-McNeil Pharmaceutical, Inc., 2003.
32. Sahm DF, Thornsberry C, Mayfield DC, Jones ME, Karlowsky JA. Multidrug-resistant urinary tract isolates of Escherichia coli: preva- lence and patient demographics in the United States in 2000. Antimi- crob Agents Chemother. 2001;45:1402–1406.
33. Hepburn MJ, Dooley DP, Skidmore PJ, Ellis MW, Starnes WF, Hasewinkle WC. Comparison of short-course (5 days) and standard (10 days) treatment for uncomplicated cellulitis. Arch Intern Med. 2004;164:1669 –1674.
34. Zhanel GG, Walters M, Laing N, Hoban DJ. In vitro pharmacody- namic modelling simulating free serum concentrations of fluoroquino- lones against multidrug-resistant Streptococcus pneumoniae. J Antimi- crob Chemother. 2001;47:435– 440.
35. Klepser ME, Ernst EJ, Petzold CR, Rhomberg P, Doern GV. Comparative bactericidal activities of ciprofloxacin, clinafloxacin, grepafloxacin, levo- floxacin, moxifloxacin, and trovafloxacin against Streptococcus pneu- moniae in a dynamic in vitro model. Antimicrob Agents Chemother. 2001;45:673– 678.
36. Liu H, Mulholland SG. Appropriate antibiotic treatment of genitouri- nary infections in hospitalized patients. Am J Med. 2005;118(suppl 7A):14S–20S.
37. Kardas P. Patient compliance with antibiotic treatment for respiratory tract infections. J Antimicrob Chemother. 2002;49:897–903
38. File TM Jr. Clinical efficacy of newer agents in short-duration therapy for community-acquired pneumonia. Clin Infect Dis. 2004;39(suppl 3):S159 –S164.
39. Claxton AJ, Cramer J, Pierce C. A systematic review of the associa- tions between dose regimens and medication compliance. Clin Ther. 2001;23:1296 –1310.
40. Levaquin [package insert]. Raritan, NJ: Ortho-McNeil Pharmaceutical, Inc.; 2004.
41. Cipro [package insert]. West Haven, CT: Bayer Pharmaceuticals Cor- poration; 2004.
42. Tequin [package insert]. Princeton, NJ: Bristol-Myers Squibb Com- pany; 2004.
43. Critchley IA, Cotroneo N, Pucci MJ, Mendes R (2019) The burden of antimicrobial resistance among urinary tract isolates of Escherichia coli in the United States in 2017. PLOS ONE 14(12): e0220265.
44. Paterson DL. “Collateral damage” from cephalosporin and quinolone antibiotic therapy. Clin Infect Dis 2004; 38(Suppl. 4):S341-5.
45. Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Disease Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011;5:e103-20
46. Long B., and Koyfman .: The emergency department diagnosis and treatment of UTI. Emerg Med Clin North Am 2018; 36:pp 685-710
47. Ronald A.: The etiology of urinary tract infection: traditional and emerging pathogens. Am J Med 2002; 113:pp. 14S-19S