Abstract
Uncomplicated urinary tract infections (uUTIs) are common in adult women across the entire age spectrum, with mean annual incidences of approximately 15% and 10% in those aged 15–39 and 40–79 years, respectively. By definition, UTIs in males or pregnant females and those associated with risk factors known to increase the risk of infection or treatment failure (e.g. acquisition in a hospital setting, presence of an indwelling urinary catheter, urinary tract instrumentation/interventions, diabetes mellitus or immunosuppression) are not considered herein.
The majority of uUTIs are caused by Escherichia coli (70–95%), with Proteus mirabilis, Klebsiella spp. and Staphylococcus saprophyticus accounting for 1–2%, 1–2% and 5–10% of infections, respectively. If clinical signs and symptoms consistent with uUTI are present (e.g. dysuria, frequency, back pain or costovertebral angle tenderness) and there is no vaginal discharge or irritation present, the likelihood of uUTI is >90–95%. Laboratory testing (i.e. urinary nitrites, leukocyte esterase, culture) is not necessary in this circumstance and empirical treatment can be initiated.
The ever-increasing incidence of antimicrobial resistance of the common uropathogens in uUTI has been and is a continuing focus of intensive study. Resistance to cotrimoxazole (trimethoprim/sulfamethoxazole) has made the empirical use of this drug problematic in many geographical areas. If local uropathogen resistance rates to cotrimoxazole exceed 10–25%, empirical cotrimoxazole therapy should not be utilized (fluoroquinolones become the new first-line agents). In a few countries, uropathogen resistance rates to the fluoroquinolones now exceed 10–25%, rendering empirical use of fluoroquinolones problematic. With the exception of fosfomycin (a second-line therapy), single-dose therapy is not recommended because of suboptimal cure rates and high relapse rates. Cotrimoxazole and the fluoroquinolones can be administered in 3-day regimens. Nitrofurantoin, a second-line therapy, should be given for 7 days. β-Lactams are not recommended because of suboptimal clinical and bacteriological results compared with those of non-β-lactams. If a β-lactam is chosen, it should be given for 7 days.
Management of uUTIs can frequently be triaged to non-physician healthcare personnel without adverse clinical consequences, resulting in substantial cost savings. It can be anticipated that the optimal approach to the management of uUTIs will change substantially in the future as a consequence of antimicrobial resistance.
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References
Richards DA, Toop LJ, Chambers ST, et al. Antibiotic resistance in uncomplicated urinary tract infection: problems with interpreting cumulative resistance rates from local community laboratories. New Zealand Med J 2002 Jan 25; 115(1146): 12–4
Car J. Urinary tract infections in women: diagnosis and management in primary care. BMJ 2006 Jan 14; 332(7533): 94–7
Czaja CA, Hooton TM. Update on acute uncomplicated urinary tract infection in women. Postgrad Med 2006 Jun–Jul; 119(1): 39–45
Foxman B, Brown P. Epidemiology of urinary tract infections: transmission and risk factors, incidence, and costs. Infect Dis Clin North Am 2003 Jun; 17(2): 227–41
Bass 3rd PF, Jarvis JA, Mitchell CK. Urinary tract infections. Prim Care Clin 2003 Mar; 30(1): 41–61
Ki M, Park T, Choi BY, et al. The epidemiology of acute pyelonephritis in South Korea, 1997–1999. Am J Epidemiol 2004; 160: 985–93
Laupland KB, Ross T, Pitout JD, et al. Community-acquired urinary tract infections: a population-based assessment. Infection 2007 Jun; 35(3): 150–3
Hooton TM. The current management strategies for community-acquired urinary tract infection. Infect Dis Clin North Am 2003 Jun; 17(2): 303–32
Naber KG, Bergman B, Bishop MC, et al. EAU guidelines for the management of urinary and male genital tract infections. Eur Urol 2001; 40: 576–88
Ferry SA, Holm SE, Stenlund H, et al. The natural course of uncomplicated lower urinary tract infection in women illustrated by a randomized placebo controlled study. Scand J Infect Dis 2004; 36(4): 296–301
Godaly G, Svanborg C. Urinary tract infections revisited. Kidney Int 2007 Apr; 71(8): 721–3
Bullitt E, Makowski L. Structure polymorphism of bacterial adhesion pili. Nature 1995; 373: 164–7
Bergsten G, Wullt B, Schembri MA, et al. Do type 1 fimbriae promote inflammation in the human urinary tract? Cell Microbiol 2007 Jul; 9(7): 1766–81
Ulett GC, Valle J, Beloin C, et al. Functional analysis of antigen 43 in uropathogenic Escherichia coli reveals a role in long-term persistence in the urinary tract. Infect Immunol 2007 Jul; 75(7): 3233–44
Zasloff M. Antimicrobial peptides, innate immunity, and the normally sterile urinary tract. J Am Soc Nephrol 2007; 18: 2810–6
O’Brien K, Hillier S, Simpson S, et al. An observational study of empirical antibiotics for adult women with uncomplicated UTI in general practice. J Antimicrob Chemother 2007 Jun; 59(6): 1200–3
Nys S, van Merode T, Bartelds AI, et al. Urinary tract infections in general practice patients: diagnostic tests versus bacteriological culture. J Antimicrob Chemother 2006 May; 57(5): 955–8
McIsaac WJ, Low DE, Biringer A, et al. The impact of empirical management of acute cystitis on unnecessary antibiotic use. Arch Int Med 2002 Mar 10; 162(5): 600–5
Bent S, Nallamothu BK, Simel DL, et al. Does this woman have an acute uncomplicated urinary tract infection? JAMA 2002 May; 287(20): 2701–10
Batchelor BI, Crook DW, Jones T, et al. Impact of guidelines for the diagnosis of urinary tract infection on trimethoprim susceptibility of Escherichia coli. J Antimicrob Chemother 2002 Jan; 49(1): 223–4
Gupta K, Scholes D, Stamm WE. Increasing prevalence of antimicrobial resistance among uropathogens causing acute uncomplicated cystitis in women. JAMA 1999 Feb 24; 281(8): 736–8
Karlowsky JA, Kelly LJ, Thornsberry C, et al. Susceptibility to fluoroquinolones among commonly isolated gram-negative bacilli in 2000; TRUST and TSN data for the United States. Int J Antimicrob Agents 2002; 19: 21–31
Gupta K, Sahm DF, Mayfield D, et al. Antimicrobial resistance among uropathogens that cause community-acquired urinary tract infections in women: a nationwide analysis. Clin Infect Dis 2001 Jul 1; 33(1): 89–94
Karlowsky JA, Hoban DJ, Decorby MR, et al. Fluoroquinolone-resistant urinary isolates of Escherichia coli from outpatients are frequently multidrug resistant: results from the North American Urinary Tract Infection Collaborative Alliance-Quinolone Resistance study. Antimicrob Agents Chemother 2006 Jun; 50(6): 2251–4
Kiffer CR, Mendes C, Oplustil CP, et al. Antibiotic resistance and trend of urinary pathogens in general outpatients from a major urban city. Int Braz J Urol 2007 Jan–Feb; 33(1): 42–49
Goldstein FW. Antibiotic susceptibility of bacterial strains isolated from patients with community-acquired urinary tract infections in France. Eur J Clin Microbiol Infect Dis 2000; 19: 112–7
Hummers-Pradier EVA, Koch M, Ohse AM, et al. Antibiotic resistance of urinary pathogens in female general practice patients. Scand J Infect Dis 2005; 37(4): 256–61
Ungheri D, Albini E, Belluco G. In-vitro susceptibility of quinolone-resistant clinical isolates of Escherichia coli to fosfomycin trometamol. J Chemother 2002 Jun; 14(3): 237–40
Marchese A, Gualco L, Debbia EA, et al. In vitro activity of fosfomycin against gram-negative urinary pathogens and the biological cost of fosfomycin resistance. Int J Antimicrob Agents 2003 Oct; 22 Suppl. 2: 53–9
Tempera G, Mirabile M, Mangiafico A, et al. Fosfomycin trimethamine in uncomplicated urinary tract infections: an epidemiological survey. J Chemother 2004 Apr; 16(2): 216–7
Gesu GP, Marchetti F. Increasing resistance according to patient’s age and sex in Escherichia coli isolated from urine in Italy. J Chemother 2007 Apr; 19(2): 161–5
Sociedad Espanola de Enfermedades Infecciosas y Microbiologia Clinica (SEMIC). Protocolos clinicos 2003: infeccion urinaria [online]. Available from URL: http://www.semic.org/protocolos/clinicos/index.htm [Accessed 2007 Nov 12]
Hryniewicz K, Szczypa K, Sulikowska A, et al. Antibiotic susceptibility of bacterial strains isolated from urinary tract infections in Poland. J Antimicrob Chemother 2001 Jun; 47(6): 773–80
Zemkova M, Kotlarova J, Merka V, et al. Emergence of fluoroquinolone resistance in Escherichia coli isolates at the department of clinical hematology. New Microbiol 2007 Oct; 30(4): 423–30
Gobernado M, Valdes L, Alos JI, et al. Quinolone resistance in female outpatient urinary tract isolates of Escherichia coli: age-related differences. Rev Esp Quimio 2007; 20: 206–10
Gobernado M, Valdes L, Alos JI, et al. Antimicrobial susceptibility of clinical Escherichia coli isolates from uncomplicated cystitis in women over a 1-year period in Spain. Rev Esp Quimio 2007; 20: 68–76
Garcia MI, Munoz Bellido JL, Garcia Rodriguez JA, et al. In vitro susceptibility of community-acquired urinary tract pathogens to commonly used antimicrobial agents in Spain: a comparative multicenter study (2002–2004). J Chemother 2007 Jun; 19(3): 263–70
Storby KA, Osterlund A, Kahlmeter G. Antimicrobial resistance in Escherichia coli in urine samples from children and adults: a 12 year analysis. Act Paed 2004 Apr; 93(4): 487–91
Arslan H, Azap OK, Ergonul O, et al. Risk factors for ciprofloxacin resistance among Escherichia coli strains isolated from community-acquired urinary tract infections in Turkey. J Antimicrob Chemother 2005 Nov; 56(5): 914–8
Rock W, Colodner R, Chazan B, et al. Ten years surveillance of antimicrobial susceptibility of community-acquired Escherichia coli and other uropathogens in Northern Israel (1995–2005). Isr Med Assoc J 2007 Nov; 9: 803–5
Hima-Lerible H, Menard D, Talarmin A. Antimicrobial resistance among uropathogens that cause community-acquired urinary tract infections in Bangui, Central African Republic. J Antimicrob Chemother 2003 Jan; 51(1): 192–4
Randrianirina F, Soares JL, Carod JF, et al. Antimicrobial resistance among uropathogens that cause community-acquired urinary tract infections in Antananarivo, Madagascar. J Antimicrob Chemother 2007 Feb; 59(2): 309–12
Issack MI, Yee Kin Tet HY, Morlat P. Antimicrobial resistance among enterobacteriaceae causing uncomplicated urinary tract infections in Mauritius: consequences of past misuse of antibiotics. J Chemother 2007 Apr; 19(2): 222–5
Nabeth P, Perrier-Gros-Claude J-D, Juergens-Behr A, et al. In vitro susceptibility of quinolone-resistant Enterobacteriaceae uropathogens to fosfomycin trometamol, in Dakar, Senegal. Scand J Infect Dis 2005; 37(6–7): 497–9
Dromigny JA, Nabeth P, Juergens-Behr A, et al. Risk factors for antibiotic-resistant Escherichia coli isolated from community-acquired urinary tract infections in Dakar, Senegal. J Antimicrob Chemother 2005 Jul; 56(1): 236–9
Ahmed AA, Osman H, Mansour AM, et al. Antimicrobial agent resistance in bacterial isolates from patients with diarrhea and urinary tract infection in the Sudan. Am J Trop Med Hyg 2000; 63: 259–63
Akram M, Shahid M, Khan AU. Etiology and antibiotic resistance patterns of community-acquired urinary tract infections in JNMC Hospital Aligarh, India. Ann Clin Microbiol Antimicrob 2007; 6: 4
Arya SC, Agarwal N. Re: antibiotic resistance and trend of urinary pathogens in general outpatients from a major urban city. Int Braz J Urol 2007; 33: 267–9
Kahlmeter G. An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO.SENS Project. J Antimicrob Chemother 2003 Jan; 51(1): 69–76
Urbanek K, Kolar M, Strojil J, et al. Utilization of fluoroquinolones and Escherichia coli resistance in urinary tract infection: inpatients and outpatients. Pharmacoepidemiol Drug Saf 2005 Oct; 14(10): 741–5
Brown PD, Freeman A, Foxman B. Prevalence and predictors of trimethoprim/sulphamethoxazole resistance among uropathogenic Escherichia coli isolates in Michigan. Clin Infect Dis 2002 Apr 15; 34(8): 1061–6
Wright SW, Wrenn KD, Haynes ML. Trimethoprim-sulfamethoxazole resistance among urinary coliform isolates. J Gen Intern Med 1999; 14: 606–9
McNulty CAM, Richards J, Livermore DM, et al. Clinical relevance of laboratory-reported antibiotic resistance in acute uncomplicated urinary tract infection in primary care. J Antimicrob Chemother 2006 Nov; 58(5): 1000–8
Hillier S, Roberts Z, Dunstan F, et al. Prior antibiotics and risk of antibiotic-resistant community-acquired urinary tract infection: a case-control study. J Antimicrob Chemother 2007 Jul; 60(1): 92–9
Gupta K, Stamm WE. Outcomes associated with trimethoprim/sulphamethoxazole (TMP/SMX) therapy in TMP/SMX resistant community-acquired UTI. Int J Antimicrob Agents 2002 Jun; 19(6): 554–6
Metlay JP, Strom BL, Asch DA. Prior antimicrobial drug exposure: a risk factor for trimethoprim-sulfamethoxazole-resistant urinary tract infections. J Antimicrob Chemother 2003 Apr; 51(4): 963–70
Kahan NR, Chinitz DP, Waitman DA, et al. Empiric treatment of uncomplicated urinary tract infection with fluoroquinolones in older women in Israel: another lost treatment option? Ann Pharmacother 2006 Dec; 40(12): 2223–7
Blahna MT, Zalewski CA, Reuer J, et al. The role of horizontal gene transfer in the spread of trimethoprim-sulfamethoxazole resistance among uropathogenic Escherichia coli in Europe and Canada. J Antimicrob Chemother 2006 Apr; 57(4): 666–72
Wright SW, Wrenn KD, Haynes M, et al. Prevalence and risk factors for multidrug resistant uropathogens in ED patients. Am J Emerg Med 2000 Mar; 18(2): 143–6
Mentler PA, Kuhn BR, Gandhi G. Risk stratification for trimethoprim-sulfamethoxazole resistance in community-acquired, uncomplicated urinary tract infections. Am J Health-Syst Pharm 2006 Sep 1; 63(17): 1588–90
Colodner R, Rock W, Chazan B, et al. Risk factors for the development of extended-spectrum beta-lactamase-producing bacteria in nonhospitalized patients. Eur J Clin Microbiol Infect Dis 2004 Mar; 23(3): 163–7
Marijan T, Vranes J, Bedeni B, et al. Emergence of uropathogenic extended-spectrum beta lactamases-producing Escherichia coli strains in the community. Coll Antropol 2007; 31: 227–33
Goettsch WG, Janknegt R, Herings RM. Increased treatment failure after 3-day courses of nitrofurantoin and trimethoprim for urinary tract infections in women: a population-based retrospective cohort study using the PHARMO database. Br J Clin Pharmacol 2004 Aug; 58(2): 184–9
Butler CC, Hillier S, Roberts Z, et al. Antibiotic-resistant infections in primary care are symptomatic for longer and increase workload: outcomes for patients with E. coli UTIs. Br J Gen Prac 2006 Sep; 56(530): 686–92
Lawrenson RA, Logie JW. Antibiotic failure in the treatment of urinary tract infections in young women. J Antimicrob Chemother 2001 Dec; 48(6): 895–901
Gupta K. Emerging antibiotic resistance in urinary tract pathogens. Infect Dis Clin North Am 2003 Jun; 17(2): 243–59
Gross PA, Patel B. Reducing antibiotic overuse: a call for a national performance measure for not treating asymptomatic bacteriuria. Clin Infect Dis 2007 Nov 15; 45(10): 1335–7
Hillier S, Bell J, Heginbothom M, et al. When do general practitioners request urine specimens for microbiology analysis? The applicability of antibiotic resistance surveillance based on routinely collected data. J Antimicrob Chemother 2006 Dec; 58(6): 1303–6
Galatti L, Sessa A, Mazzaglia G, et al. Antibiotic prescribing for acute and recurrent cystitis in primary care: a 4 year descriptive study. J Antimicrob Chemother 2006 Mar; 57(3): 551–6
Huang ES, Stafford RS. National patterns in the treatment of urinary tract infections in women by ambulatory care physicians. Arch Int Med 2002 Jan 14; 162(1): 41–7
Kallen AJ, Welch HG, Sirovich BE. Current antibiotic therapy for isolated urinary tract infections in women. Arch Int Med 2006 Mar 27; 166(6): 635–9
Wigton RS, Longenecker JC, Bryan TJ, et al. Variation by specialty in the treatment of urinary tract infection in women. J Gen Int Med 1999 Aug; 14(8): 491–4
Lautenbach E, Larosa LA, Kasbekar N, et al. Fluoroquinolone utilization in the emergency departments of academic medical centers: prevalence of, and risk factors for, inappropriate use. Arch Int Med 2003 Mar 10; 163(5): 601–5
Iravani A, Tice AD, McCarty J, et al. Short-course ciprofloxacin treatment of acute uncomplicated urinary tract infection in women: the minimum effective dose. Arch Intern Med 1995 Mar 13; 155(5): 485–94
Vogel T, Verreault R, Gourdeau M, et al. Optimal duration of antibiotic therapy for uncomplicated urinary tract infection in older women: a double-blind randomized controlled trial. CMAJ 2004 Feb 17; 170(4): 469–73
Arredondo-Garcia JL, Figueroa-Damian R, Rosas A, et al. Comparison of short-term treatment regimen of ciprofloxacin versus long-term treatment regimens of trimethoprim/sulfamethoxazole or norfloxacin for uncomplicated lower urinary tract infections: a randomized, multicentre, open-label, prospective study. J Antimicrob Chemother 2004 Oct; 54(4): 840–3
Hooten TM, Scholes D, Gupta K, et al. Amoxicillin-clavulanate vs ciprofloxacin for the treatment of uncomplicated cystitis in women. a randomized trial. JAMA 2005 Feb 23; 293(8): 949–55
Richard GA, Mathew CP, Kirstein JM, et al. Single-dose fluoroquinolone therapy of acute uncomplicated urinary tract infection in women: results from a randomized, double-blind, multicenter trial comparing single-dose to 3-day fluoroquinolone regimens. Urology 2002 Mar; 59(3): 334–9
Iravani A, Klimberg I, Briefer C, et al. A trial comparing low-dose, short-course ciprofloxacin and standard 7 day therapy with co-trimoxazole or nitroflurantoin in the treatment of uncomplicated urinary tract infections. J Antimicrob Chemother 1999; 43 Suppl. A: 67–75
McCarty JM, Richard G, Huck W, et al. A randomized trial of short-course ciprofloxacin, ofloxacin, or trimethoprim/sulfamethoxazole for the treatment of acute urinary tract infection in women. Am J Med 1999 Mar; 106(3): 292–9
Schaeffer AJ, Stuppy BA. Efficacy and safety of self-start therapy in women with recurrent urinary tract infections. J Urol 1999 Jan; 161(1): 207–11
Henry Jr DC, Bettis RB, Riffer E, et al. Comparison of once-daily extended-release ciprofloxacin and conventional twice-daily ciprofloxacin for the treatment of uncomplicated urinary tract infection in women. Clin Ther 2002 Dec; 24(12): 2088–104
Fourcroy JL, Berner B, Chiang YK, et al. Efficacy and safety of a novel once-daily extended-release ciprofloxacin tablet formulation for treatment of uncomplicated urinary tract infection in women. Antimicrob Agents Chemother 2005 Oct; 49(10): 4137–43
Bonfiglio G, Mattina R, Lanzafame A, et al. Fosfomycin tromethamine in uncomplicated urinary tract infections: a clinical study. Chemotherapy 2005 May; 51(2–3): 162–6
Lobel B. Short term therapy for uncomplicated urinary tract infection today: clinical outcome upholds the theories. Int J Antimicrob Agents 2003 Oct; 22 Suppl. 2: 85–7
Gupta K, Hooton TM, Stamm WE. Isolation of fluoroquinolone-resistant rectal Escherichia coli after treatment of acute uncomplicated cystitis. J Antimicrob Chemother 2005 Jul; 56(1): 243–6
Stein GE. Comparison of single-dose fosfomycin and a 7-day course of nitrofurantoin in female patients with uncomplicated urinary tract infection. Clin Ther 1999; 21: 1864–72
Minassian MA, Lewis DA, Chattopadhyay D, et al. A comparison between single-dose fosfomycin trametamol (Monuril®) and a 5-day course of trimethoprim in the treatment of uncomplicated lower urinary tract infection. Int J Antimicrob Agents 1998; 10: 39–47
Raz R, Chazan B, Kennes Y, et al. Empirical use of trimethoprim/sulphamethoxazole (TMP-SMX) in the treatment of women with uncomplicated urinary tract infections, in a geographical area with a high prevalence of TMP-SMX-resistant uropathogens. Clin Infect Dis 2002 May 1; 34(9): 1165–9
Christiaens TC, DeMeyere M, Verschraegen G, et al. Randomised controlled trial of nitrofurantoin versus placebo in the treatment of uncomplicated urinary tract infection in adult women. Br J Gen Prac 2002 Sep; 52(482): 729–34
Nicolle LE, Madsen KS, Debeeck GO, et al. Three days of pivmecillinam or norfloxacin for treatment of acute uncomplicated urinary infection in women. Scand J Infect Dis 2002; 34(7): 487–92
Hooton TM, Winter C, Tiu F, et al. Randomized comparative trial and cost analysis of 3-day antimicrobial regimens for treatment of acute cystitis in women. JAMA 1995 Jan 4; 273(1): 41–5
Masterton RG, Bochsler JA. High-dose co-amoxiclav in a single dose versus 7 days of co-trimoxazole as treatment of uncomplicated lower urinary tract infection in women. J Antimicrob Chemother 1995 Jan; 35(1): 129–37
Leigh AP, Nemeth MA, Keyserling CH, et al. Cefdinir versus cefaclor in the treatment of uncomplicated urinary tract infection. Clin Ther 2000; 22: 818–25
Nicolle LE, Hoepelman AIM, Floor M, et al. Comparison of three days’ therapy with cefcanel or amoxicillin for the treatment of acute uncomplicated urinary tract infection. Scand J Infect Dis 1993; 25(5): 631–7
Gupta K, Hooten TM, Roberts PL, et al. Short-course nitrofurantoin for the treatment of acute uncomplicated cystitis in women. Arch Intern Med 2007 Nov 12; 167(20): 2207–12
O’Connor KA, Kingston M, Twomey C, et al. A trial comparing standard trimethoprim therapy with nitrofurantoin in the treatment of uncomplicated urinary tract infections in elderly patients [abstract]. Age Ageing 2002 Feb; 31 Suppl. 1: 13
Talan DA, Stamm WE, Hooten TM, et al. Comparison of ciprofloxacin (7 days) and trimethoprim-sulfamethoxazole (14 days) for acute uncomplicated pyelonephritis in women. a randomized trial. JAMA 2000 Mar 22/29; 283(12): 1583–90
Rubin RH, Shapiro ED, Andriole VT, et al. Evaluation of new anti-infective drugs for the treatment of urinary tract infection. Clin Infect Dis 1992 Nov; 15 Suppl. 1: S216–27
DeAlleaume L, Tweed EM. When are empiric antibiotics appropriate for urinary tract infection symptoms? J Fam Prac 2006 Apr; 55(4): 338, 341–2
Kahan NR, Friedman NL, Lomnicky Y, et al. Physician speciality and adherence to guidelines for the treatment of unsubstantiated uncomplicated urinary tract infection among women. Pharmacoepidemiol Drug Saf 2005 May; 14(5): 357–61
Barry HC, Ebell MH, Hickner J. Evaluation of suspected urinary tract infection in ambulatory women: a cost-utility analysis of office-based strategies. J Fam Prac 1997; 44: 49–60
Richards D, Toop L, Chambers S, et al. Response to antibiotics of women with symptoms of urinary tract infection but negative dipstick urine test results: a double-blind randomized controlled trial. BMJ 2005 Jul 16; 331(7509): 143
Ejrnaes K, Sandvang D, Lundgren B, et al. Pulsed-field gel electrophoresis typing of Escherichia coli strains from samples collected before and after pivmecillinam or placebo treatment of uncomplicated community-acquired urinary tract infection in women. J Clin Microbiol 2006 May; 44(5): 1776–81
Rosen DA, Hooten TM, Stamm WE, et al. Detection of intra-cellular bacterial communities in human urinary tract infections. PLOS Med 2007 Dec; 4(12): 1949–58
Ottiger C, Schaer G, Huber AR. Time-course of quantitative urinary leukocytes and bacteria counts during antibiotic therapy in women with symptoms of urinary tract infection. Clin Chim Acta 2007 Apr; 379(1–2): 36–41
Vinson DR, Quesenberry Jr CP. The safety of telephone management of presumed cystitis in women. Arch Intern Med 2004 May 10; 164(9): 1026–9
Barry HC, Hickner J, Ebell MH, et al. A randomized controlled trial of telephone management of suspected urinary tract infections in women. J Fam Prac 2001 Jul; 50(7): 589–94
Saint S, Scholes D, Fihn SD, et al. The effectiveness of a clinical practice guideline for the management of presumed uncomplicated urinary tract infection in women. Am J Med 1999 Jun; 106(6): 636–41
Aagaard EM, Nadler P, Adler J, et al. An interactive computer kiosk module for the treatment of recurrent uncomplicated cystitis in women. J Gen Int Med 2006 Nov; 21(11): 1156–9
Schauberger CW, Merkitch KW, Prell AM. Acute cystitis in women: experience with a telephone-based algorithm. Wisc Med J 2007; 106(6): 326–9
McIsaac WJ, Moineddin R, Ross S. Validation of a decision aid to assist physicians in reducing unnecessary antibiotic drug use for acute cystitis. Arch Intern Med 2007 Nov 12; 167(20): 2201–6
Gupta K, Hooten TM, Roberts PL, et al. Patient-initiated treatment of uncomplicated recurrent urinary tract infections in young women. Ann Intern Med 2001 Jul 3; 135(1): 9–16
Lee BB, Simpson JM, Craig JC, et al. Methenamine hippurate for preventing urinary tract infections. Cochrane Database Syst Rev 2007; (4): CD003265
Albert X, Huertas I, Pereiro II, et al. Antibiotics for preventing recurrent urinary tract infections in non-pregnant women. Cochrane Database Syst Rev 2004; (3): CD001209
Alexiou Z, Mouktaroudi M, Koratzanis G, et al. The significance of compliance for the success of antimicrobial prophylaxis in recurrent lower urinary tract infections: the Greek experience. Int J Antimicrob Ag 2007; 30: 40–3
Bauer HW, Alloussi S, Egger C, et al. A long-term, multicenter, double-blind study of an Escherichia coli extract (OM-89) in female patients with recurrent urinary tract infections. Eur Urol 2005; 47: 542–8
Darouiche RO, Thornby JI, Cerra-Stewart C, et al. Bacterial interference for prevention of urinary tract infection: a prospective, randomized, placebo-controlled, double-blind pilot trial. Clin Infect Dis 2005 Nov 15; 41(10): 1531–4
Barrons R, Tassone D. Use of Lactobacillus probiotics for bacterial genitourinary infections in women: a review. Clin Ther 2008 Mar; 30(3): 453–68
Reid G, Bruce AW. Probiotics to prevent urinary tract infections: the rationale and evidence. World J Urol 2006; 24: 28–32
McCully KS, Jackson S. Hormone replacement therapy and the bladder. J Br Menopause Soc 2004 Mar; 10(1): 30–2
Rozenberg S, Pastijn A, Gevers R, et al. Estrogen therapy in older patients with recurrent urinary tract infections: a review. Int J Fertil Womens Med 2004 Mar–Apr; 49(2): 71–74
Andre M, Molstad S, Lundborg GS, et al. Management of urinary tract infections in primary care: a repeated 1-week diagnosis-prescribing study in five counties in Sweden in 2000 and 2002. Scand J Infect Dis 2004; 36(2): 134–8
Martinez MA, Inglada L, Ochoa C, et al. Assessment of antibiotic prescription in acute urinary tract infections in adults. J Infect 2007; 54: 235–44
Warren JW, Abrutyn E, Hebel JR, et al. Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis. Clin Infect Dis 1999 Oct; 29(4): 745–58
Kahan E, Kahan NR, Chinitz DP. Urinary tract infection in women. Physician’s preferences for treatment and adherence to guidelines: a national drug utilization study in a managed care setting. Eur J Clin Pharmacol 2003 Nov; 59(8–9): 663–8
Grover ML, Bracamonte JD, Kanodia AK, et al. Assessing adherence to evidence-based guidelines for the diagnosis and management of uncomplicated urinary tract infection. Mayo Clin Proc 2007 Feb; 82(2): 181–5
O’Connor PJ, Solberg LI, Christianson J, et al. Mechanism of action and impact of a cystitis clinical practice guideline on outcomes and costs of care in an HMO. Jt Comm J Qual Improv 1996; 22: 673–82
Taur Y, Smith MA. Adherence to the Infectious Diseases Society of America guidelines in the treatment of uncomplicated urinary tract infection. Clin Infect Dis 2007 Mar 15; 44(6): 769–74
Kahan NR, Chinitz DP, Waitman DA, et al. Empiric treatment of uncomplicated UTI in women: wasting money when more is not better. J Clin Pharm Ther 2004 Oct; 29(5): 437–41
Kahan NR, Chinitz DP, Kahan E. Longer than recommended empiric antibiotic treatment of urinary tract infection in women: an avoidable waste of money. J Clin Pharm Ther 2004 Feb; 29(1): 59–63
Kahan NR, Chinitz DP, Kahan E. Physician adherence to recommendations for duration of empiric antibiotic treatment for uncomplicated urinary tract infection in women: a national drug utilization analysis. Pharmacoepidemiol Drug Saf 2004 Apr; 13(4): 239–42
Le TP, Miller LG. Empirical therapy for uncomplicated urinary tract infections in an era of increasing antimicrobial resistance: a decision and cost analysis. Clin Infect Dis 2001 Sep 1; 33(5): 615–21
Berger RE. Duration of antibacterial treatment for uncomplicated urinary tract infection in women. J Urology 2006 Mar; 175(3): 968
Nickel JC. Management of urinary tract infections: historical perspective and current strategies: part 2, modern management. J Urology 2005 Jan; 173(1): 27–32
Gentry LO. Cephalosporins in urinary tract infection. Drugs 1987; 34 Suppl. 2: 154–63
Miller LG, Mehrotra R, Tang AW. Does in vitro fluoroquinolone resistance predict clinical failure in urinary tract infections? Int J Antimicrob Agents 2007; 29: 605–7
Stamey TA, Fair WR, Timothy MM, et al. Serum versus urinary antimicrobial concentrations in the cure of urinary-tract infections N Engl J Med 1974 Nov 28; 291(22): 1159–1163
Kaiser J, McPherson V, Kaufmann L. Which UTI therapies are safe and effective during breastfeeding? J Fam Prac 2007 Mar; 56(3): 225–6, 228
Johnson JR, Owens K, Gajewski A, et al. Escherichia coli colonization patterns among human household members and pets, with attention to acute urinary tract infection. J Infect Dis 2008 Jan 15; 197(2): 218–24
Ong CL, Ulett GC, Mabbett AN, et al. Identification of type 3 fimbriae in uropathogenic Escherichia coli reveals a role in biofilm formation. J Bacteriol 2008 Feb; 190(3): 1054–63
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Guay, D.R.P. Contemporary Management of Uncomplicated Urinary Tract Infections. Drugs 68, 1169–1205 (2008). https://doi.org/10.2165/00003495-200868090-00002
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DOI: https://doi.org/10.2165/00003495-200868090-00002