UTI in Primary Care: Are we Prescribing Too Much?

H. Hammod
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Abstract

Objectives: The aim of this article were to review usefulness of early clinical detection of UTI without lab tests as diagnostic tool for UTI in primary care and to describe when to start antibiotic treatment for management of UTI according to international guidelines. The emphasis of this review is uncomplicated UTI. Methods: A search was conducted on PubMed and official webpages of major urological, infectious diseases and general practice organisations to identify peer reviewed original articles and reviews, using the search terms ‘UTI’. I considered only papers written in English, with emphasis on more recent articles published up to July 2023. Results: There is a variation in recommendations between guidelines can be a source of confusion and controversy for clinicians in primary care. However, early detection and treatment, education of patients and removal of risk factors may reduce the number of symptomatic episodes, antibiotics usage and antimicrobial resistance in primary care. Conclusion: The diagnosis of acute uncomplicated cystitis in healthy women can be made with reasonable certainty by evaluation of symptoms and signs without a doctor’s visit or urine tests. Individualised assessment of risk factors and previous clinical history is needed to choose the most suitable antimicrobial treatment. Immediate antimicrobial therapy with Trimethoprim-sulfamethoxazole (160/800 mg twice daily for 3 days), Nitrofurantoin (100 mg twice daily for 5-7 days), or Fosfomycin (3g in a single dose) is indicated for acute cystitis in adult women. However, local guidelines advice that immediate antibiotic treatment was not considered necessary for women with uncomplicated lower UTI. Antimicrobial resistance have complicated treatment of UTI worldwide.
初级保健中的尿路感染:我们开得太多了吗?
目的:这篇文章的目的是回顾早期临床检测尿路感染没有实验室测试作为诊断工具在初级保健尿路感染的有用性,并描述何时开始抗生素治疗尿路感染管理根据国际指南。本综述的重点是简单的尿路感染。方法:在PubMed和主要泌尿科、传染病和全科组织的官方网页上进行搜索,以识别同行评议的原创文章和评论,搜索词为“UTI”。我只考虑了用英语写的论文,重点是在2023年7月之前发表的更近的文章。结果:指南之间的建议存在差异,这可能是初级保健临床医生混淆和争议的来源。然而,早期发现和治疗、对患者进行教育和消除危险因素可能会减少初级保健中出现症状的次数、抗生素的使用和抗菌素耐药性。结论:健康女性急性无合并症膀胱炎的诊断可通过症状和体征的评估而有合理的确定性,无需去看医生或进行尿液检查。需要对危险因素和既往临床病史进行个体化评估,以选择最合适的抗菌药物治疗。成年妇女急性膀胱炎应立即使用甲氧苄啶-磺胺甲恶唑(160/800毫克,每日2次,连用3天)、呋喃妥因(100毫克,每日2次,连用5-7天)或磷霉素(3克,单剂量)进行抗菌治疗。然而,当地指南建议,对于没有并发症的下尿路感染的妇女,没有必要立即进行抗生素治疗。抗菌素耐药性使全世界尿路感染的治疗复杂化。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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