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*Acute uncomplicated cystitis definition includes Premenopausal, nonpregnant women with no known urological abnormalities or comorbidities,[[postmenopause|postmenopausal]] women or well-controlled diabetic female patients.<ref name="pmid21292654">{{cite journal| author=Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG et al.| title=International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. | journal=Clin Infect Dis | year= 2011 | volume= 52 | issue= 5 | pages= e103-20 | pmid=21292654 | doi=10.1093/cid/ciq257 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21292654 }} </ref> | *Acute uncomplicated cystitis definition includes Premenopausal, nonpregnant women with no known urological abnormalities or comorbidities,[[postmenopause|postmenopausal]] women or well-controlled diabetic female patients.<ref name="pmid21292654">{{cite journal| author=Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG et al.| title=International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. | journal=Clin Infect Dis | year= 2011 | volume= 52 | issue= 5 | pages= e103-20 | pmid=21292654 | doi=10.1093/cid/ciq257 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21292654 }} </ref> | ||
*The decision to use antimicrobials should be case | *The decision to use antimicrobials should be case based, in other words it should depend on the patients specifics like allergy and compliance history, availability and cost of treatment and resistant rates at the local community. | ||
*Being the most common cause of cystitis (75-90%), [[E.Coli]] susceptibility should be considered | *Being the most common cause of cystitis (75-90%), [[E.Coli]] susceptibility should be considered when choosing the appropriate empirical antimicrobial. Other organisms like [[Proteus mirabilis]], [[Klebsiella pneumoniae]] and [[Staphylococcus saprophyticus]] are less common. | ||
*[[Nitrofurantoin]], [[ | *[[Nitrofurantoin]], [[Fosfomycin]] and [[Mecillinam ]]are prefered as first line treatment because they have less resistance among other antibacterials <ref name="Kahlmeter-2003">{{Cite journal | last1 = Kahlmeter | first1 = G. | title = An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO.SENS Project. | journal = J Antimicrob Chemother | volume = 51 | issue = 1 | pages = 69-76 | month = Jan | year = 2003 | doi = | PMID = 12493789 }}</ref><ref name="Naber-2008">{{Cite journal | last1 = Naber | first1 = KG. | last2 = Schito | first2 = G. | last3 = Botto | first3 = H. | last4 = Palou | first4 = J. | last5 = Mazzei | first5 = T. | title = Surveillance study in Europe and Brazil on clinical aspects and Antimicrobial Resistance Epidemiology in Females with Cystitis (ARESC): implications for empiric therapy. | journal = Eur Urol | volume = 54 | issue = 5 | pages = 1164-75 | month = Nov | year = 2008 | doi = 10.1016/j.eururo.2008.05.010 | PMID = 18511178 }}</ref>with similar efficacy.<ref name="Gupta-2007">{{Cite journal | last1 = Gupta | first1 = K. | last2 = Hooton | first2 = TM. | last3 = Roberts | first3 = PL. | last4 = Stamm | first4 = WE. | title = Short-course nitrofurantoin for the treatment of acute uncomplicated cystitis in women. | journal = Arch Intern Med | volume = 167 | issue = 20 | pages = 2207-12 | month = Nov | year = 2007 | doi = 10.1001/archinte.167.20.2207 | PMID = 17998493 }}</ref><ref name="Iravani-1999">{{Cite journal | last1 = Iravani | first1 = A. | last2 = Klimberg | first2 = I. | last3 = Briefer | first3 = C. | last4 = Munera | first4 = C. | last5 = Kowalsky | first5 = SF. | last6 = Echols | first6 = RM. | title = A trial comparing low-dose, short-course ciprofloxacin and standard 7 day therapy with co-trimoxazole or nitrofurantoin in the treatment of uncomplicated urinary tract infection. | journal = J Antimicrob Chemother | volume = 43 Suppl A | issue = | pages = 67-75 | month = Mar | year = 1999 | doi = | PMID = 10225575 }}</ref><ref name="Stein-1999">{{Cite journal | last1 = Stein | first1 = GE. | title = Comparison of single-dose fosfomycin and a 7-day course of nitrofurantoin in female patients with uncomplicated urinary tract infection. | journal = Clin Ther | volume = 21 | issue = 11 | pages = 1864-72 | month = Nov | year = 1999 | doi = 10.1016/S0149-2918(00)86734-X | PMID = 10890258 }}</ref><ref name="Minassian-1998">{{Cite journal | last1 = Minassian | first1 = MA. | last2 = Lewis | first2 = DA. | last3 = Chattopadhyay | first3 = D. | last4 = Bovill | first4 = B. | last5 = Duckworth | first5 = GJ. | last6 = Williams | first6 = JD. | title = A comparison between single-dose fosfomycin trometamol (Monuril) and a 5-day course of trimethoprim in the treatment of uncomplicated lower urinary tract infection in women. | journal = Int J Antimicrob Agents | volume = 10 | issue = 1 | pages = 39-47 | month = Apr | year = 1998 | doi = | PMID = 9624542 }}</ref> | ||
*[[TMP-SMX]] is preferred | *[[TMP-SMX]] is preferred in areas where the resistance rates are less than 20%.<ref name="Gupta-2003">{{Cite journal | last1 = Gupta | first1 = K. | title = Emerging antibiotic resistance in urinary tract pathogens. | journal = Infect Dis Clin North Am | volume = 17 | issue = 2 | pages = 243-59 | month = Jun | year = 2003 | doi = | PMID = 12848469 }}</ref><ref name="Raz-2002">{{Cite journal | last1 = Raz | first1 = R. | last2 = Chazan | first2 = B. | last3 = Kennes | first3 = Y. | last4 = Colodner | first4 = R. | last5 = Rottensterich | first5 = E. | last6 = Dan | first6 = M. | last7 = Lavi | first7 = I. | last8 = Stamm | first8 = W. | title = Empiric use of trimethoprim-sulfamethoxazole (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. | journal = Clin Infect Dis | volume = 34 | issue = 9 | pages = 1165-9 | month = May | year = 2002 | doi = 10.1086/339812 | PMID = 11941541 }}</ref> | ||
*[[Nitrofurantoin]], [[ | *[[Nitrofurantoin]], [[Fosfomycin]] and Mecillinam should not be used when pyelonephritis is suspected, because they have weak penetration to the renal tissue. | ||
*Use of broad-spectrum antimicrobials like [[ | *Use of broad-spectrum antimicrobials like [[Fluoroquinolones]] have resulted in multidrug resistant organisms,<ref name="Hooton-2004">{{Cite journal | last1 = Hooton | first1 = TM. | last2 = Besser | first2 = R. | last3 = Foxman | first3 = B. | last4 = Fritsche | first4 = TR. | last5 = Nicolle | first5 = LE. | title = Acute uncomplicated cystitis in an era of increasing antibiotic resistance: a proposed approach to empirical therapy. | journal = Clin Infect Dis | volume = 39 | issue = 1 | pages = 75-80 | month = Jul | year = 2004 | doi = 10.1086/422145 | PMID = 15206056 }}</ref>so they are used as alternative to the first line drugs in case of allergy, unavailability or intolerance.<ref name="Paterson-2004">{{Cite journal | last1 = Paterson | first1 = DL. | title = Collateral damage from cephalosporin or quinolone antibiotic therapy. | journal = Clin Infect Dis | volume = 38 Suppl 4 | issue = | pages = S341-5 | month = May | year = 2004 | doi = 10.1086/382690 | PMID = 15127367 }}</ref><ref name="Ramphal-2006">{{Cite journal | last1 = Ramphal | first1 = R. | last2 = Ambrose | first2 = PG. | title = Extended-spectrum beta-lactamases and clinical outcomes: current data. | journal = Clin Infect Dis | volume = 42 Suppl 4 | issue = | pages = S164-72 | month = Apr | year = 2006 | doi = 10.1086/500663 | PMID = 16544267 }}</ref> | ||
*[[Beta-lactam]]s have less efficacy than [[ | *[[Beta-lactam]]s have less efficacy than [[Fluoroquinolones]]. While [[Ampicillin]] and [[Amoxicillin]] should be avoided due to high rate of resistance.<ref name="Rodríguez-Baño-2008">{{Cite journal | last1 = Rodríguez-Baño | first1 = J. | last2 = Alcalá | first2 = JC. | last3 = Cisneros | first3 = JM. | last4 = Grill | first4 = F. | last5 = Oliver | first5 = A. | last6 = Horcajada | first6 = JP. | last7 = Tórtola | first7 = T. | last8 = Mirelis | first8 = B. | last9 = Navarro | first9 = G. | title = Community infections caused by extended-spectrum beta-lactamase-producing Escherichia coli. | journal = Arch Intern Med | volume = 168 | issue = 17 | pages = 1897-902 | month = Sep | year = 2008 | doi = 10.1001/archinte.168.17.1897 | PMID = 18809817 }}</ref><ref name="Hooton-2005">{{Cite journal | last1 = Hooton | first1 = TM. | last2 = Scholes | first2 = D. | last3 = Gupta | first3 = K. | last4 = Stapleton | first4 = AE. | last5 = Roberts | first5 = PL. | last6 = Stamm | first6 = WE. | title = Amoxicillin-clavulanate vs ciprofloxacin for the treatment of uncomplicated cystitis in women: a randomized trial. | journal = JAMA | volume = 293 | issue = 8 | pages = 949-55 | month = Feb | year = 2005 | doi = 10.1001/jama.293.8.949 | PMID = 15728165 }}</ref> | ||
*Post-therapy urine culture is recommended only for pregnant women,<ref>{{Cite journal | last1 = Nicolle | first1 = LE. | last2 = Bradley | first2 = S. | last3 = Colgan | first3 = R. | last4 = Rice | first4 = JC. | last5 = Schaeffer | first5 = A. | last6 = Hooton | first6 = TM. | title = Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. | journal = Clin Infect Dis | volume = 40 | issue = 5 | pages = 643-54 | month = Mar | year = 2005 | doi = 10.1086/427507 | PMID = 15714408 }}</ref> multiple early recurrences with the same strain of bacteria and for persistent [[hematuria]]. | *Post-therapy urine culture is recommended only for pregnant women,<ref>{{Cite journal | last1 = Nicolle | first1 = LE. | last2 = Bradley | first2 = S. | last3 = Colgan | first3 = R. | last4 = Rice | first4 = JC. | last5 = Schaeffer | first5 = A. | last6 = Hooton | first6 = TM. | title = Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. | journal = Clin Infect Dis | volume = 40 | issue = 5 | pages = 643-54 | month = Mar | year = 2005 | doi = 10.1086/427507 | PMID = 15714408 }}</ref> multiple early recurrences with the same strain of bacteria and for persistent [[hematuria]]. | ||
===Acute Uncomplicated Cystitis=== | ===Acute Uncomplicated Cystitis=== | ||
| Line 27: | Line 27: | ||
===Complicated/Catheter Associated cystitis=== | ===Complicated/Catheter Associated cystitis=== | ||
Cases of Complicated cystitis include: all men with the infection, pregnant women, children with metabolic or anatomical abnoramlities, and all patients with risk of serious complications and/or failure of treatment(stones, obstruction, immunocompromised patients, neurogenic bladder, renal failure,transplant patients) considered as complicated infections<ref>{{Cite journal | last1 = Hooton | first1 = TM. | title = Clinical practice. Uncomplicated urinary tract infection. | journal = N Engl J Med | volume = 366 | issue = 11 | pages = 1028-37 | month = Mar | year = 2012 | doi = 10.1056/NEJMcp1104429 | PMID = 22417256 }}</ref> | |||
*Urinary infections in catheterized patients tend to be polymicrobial with more resistant uropathogens. | *Urinary infections in catheterized patients tend to be polymicrobial with more resistant uropathogens. | ||
*'''Urine culture''':should be taken before initiation the antimicrobial therapy.<ref name="Nicolle-2001">{{Cite journal | last1 = Nicolle | first1 = LE. | title = A practical guide to antimicrobial management of complicated urinary tract infection. | journal = Drugs Aging | volume = 18 | issue = 4 | pages = 243-54 | month = | year = 2001 | doi = | PMID = 11341472 }}</ref> For infected patients with indwelling catheters more than 2 weeks, the catheter should be replaced, and urine culture should be sampled from the new catheter to improve the | *'''Urine culture''':should be taken before initiation the antimicrobial therapy.<ref name="Nicolle-2001">{{Cite journal | last1 = Nicolle | first1 = LE. | title = A practical guide to antimicrobial management of complicated urinary tract infection. | journal = Drugs Aging | volume = 18 | issue = 4 | pages = 243-54 | month = | year = 2001 | doi = | PMID = 11341472 }}</ref> For infected patients with indwelling catheters more than 2 weeks, the catheter should be replaced, and urine culture should be sampled from the new catheter to improve the outcome of treatment with less complications.<ref name="Raz-2000">{{Cite journal | last1 = Raz | first1 = R. | last2 = Schiller | first2 = D. | last3 = Nicolle | first3 = LE. | title = Chronic indwelling catheter replacement before antimicrobial therapy for symptomatic urinary tract infection. | journal = J Urol | volume = 164 | issue = 4 | pages = 1254-8 | month = Oct | year = 2000 | doi = | PMID = 10992375 }}</ref> | ||
====Duration of Treatment==== | ====Duration of Treatment==== | ||
* | *The duration of treatment depends on the response to treatment regardless of whether the catheter is still in place. For quick resolution, a 7 days regimen is recommended, while patients with delayed clinical improvement need an extended treatment regimen of 10-14 days.<ref name="-1992">{{Cite journal | title = The prevention and management of urinary tract infections among people with spinal cord injuries. National Institute on Disability and Rehabilitation Research Consensus Statement. January 27-29, 1992. | journal = J Am Paraplegia Soc | volume = 15 | issue = 3 | pages = 194-204 | month = Jul | year = 1992 | doi = | PMID = 1500945 }}</ref> | ||
*For mild catheter associated | *For mild catheter-associated UTIs, [[Levofloxacin]] for 5 days is recommended. A 3 day regimen of antimicrobials is recommended for women ≤ 65 with lower urinary symptoms only after catheter removal.<ref name="Mohler-1987">{{Cite journal | last1 = Mohler | first1 = JL. | last2 = Cowen | first2 = DL. | last3 = Flanigan | first3 = RC. | title = Suppression and treatment of urinary tract infection in patients with an intermittently catheterized neurogenic bladder. | journal = J Urol | volume = 138 | issue = 2 | pages = 336-40 | month = Aug | year = 1987 | doi = | PMID = 3496470 }}</ref> | ||
===Cystitis in Pregnancy=== | ===Cystitis in Pregnancy=== | ||
*Urine culture is obtained after completion of antimicrobials regimen. | *Urine culture is obtained after completion of antimicrobials regimen. | ||
*[[Nitrofurantoin]] and [[Sulfonamides]] (category B) are not preferred | *[[Nitrofurantoin]] and [[Sulfonamides]] (category B) are not preferred before delivery. [[ Nitrofurantoin]] should be avoided when [[G6PD]] deficiency is suspected with the fetus due to the risk of [[hemolytic anemia]].<ref>{{Cite journal | last1 = Ben David | first1 = S. | last2 = Einarson | first2 = T. |last3 = Ben David | first3 = Y. | last4 = Nulman | first4 = I. | last5 = Pastuszak | first5 = A. | last6 = Koren | first6 = G. | title = The safety of nitrofurantoin during the first trimester of pregnancy: meta-analysis. | journal = Fundam Clin Pharmacol | volume = 9 | issue = 5 | pages = 503-7 |month = | year = 1995 | doi = | PMID = 8617414 }}</ref> [[Sulfonamides]] have been associated with increased unbound [[bilirubin]] levels in fetal blood and [[kernicterus]]. | ||
*[[Trimethoprim]] (category C) is a folic acid | *[[Trimethoprim]] (category C) is a folic acid antagonist, therefore it is not used in the first trimester to avoid the risk of possible birth defects.<ref>{{Cite journal | last1 = Crider | first1 = KS. | last2 = Cleves | first2 = MA. | last3 = Reefhuis | first3 = J. | last4 = Berry | first4 = RJ. | last5 = Hobbs | first5 = CA. | last6 = Hu | first6 = DJ. | title = Antibacterial medication use during pregnancy and risk of birth defects: National Birth Defects Prevention Study. | journal = Arch Pediatr Adolesc Med | volume = 163 | issue = 11 | pages = 978-85 | month = Nov | year = 2009 | doi = 10.1001/archpediatrics.2009.188 | PMID = 19884587 }}</ref> | ||
===Recurrent Cystitis=== | ===Recurrent Cystitis=== | ||
Recurrent cystitis suggests antimicrobial resistance. | Recurrent cystitis suggests antimicrobial resistance. | ||
* | *When there is recurrence or persistence of urinary symptoms within 1-2 weeks of treatment of uncomplicated cystitis, broad spectrum [[fluoroquinolones]] should be initiated after a urine culture. | ||
* | *Recurrent cystitis that occurs at least one month after successful treatment is treated with a short course (7 days) of first line antimicrobial therapy, . | ||
*Recurrence within 6 month of successful treatment should be treated with another first line agent than the one used first time.<ref>{{Cite journal | last1 = Hooton | first1 = TM. | title = Clinical practice. Uncomplicated urinary tract infection. | journal = N Engl J Med | volume = 366 | issue = 11 | pages = 1028-37 | month = Mar | year = 2012 |doi = 10.1056/NEJMcp1104429 | PMID = 22417256 }}</ref> | *Recurrence within 6 month of successful treatment should be treated with another first line agent than the one used first time.<ref>{{Cite journal | last1 = Hooton | first1 = TM. | title = Clinical practice. Uncomplicated urinary tract infection. | journal = N Engl J Med | volume = 366 | issue = 11 | pages = 1028-37 | month = Mar | year = 2012 |doi = 10.1056/NEJMcp1104429 | PMID = 22417256 }}</ref> | ||
*In postmenopausal women, it's recommended to evaluate correctable factors like [[cystocele]], [[incontinence]] and residual urine volume ≥50 ml. | *In postmenopausal women, it's recommended to evaluate correctable factors like [[cystocele]], [[incontinence]] and residual urine volume ≥50 ml. | ||
Revision as of 13:11, 17 August 2015
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Steven C. Campbell, M.D., Ph.D.
Overview
Antimicrobial therapy is indicated in cystitis. The treatment of cystitis depends on the disease course (acute uncomplicated vs. complicated) and the rates of resistance in the community. Due to the risk of the infection spreading to the kidneys (complicated UTI) and the high complication rate in diabetics and the elderly population, prompt treatment is almost always recommended.
Principles of Medical Therapy
- Acute uncomplicated cystitis definition includes Premenopausal, nonpregnant women with no known urological abnormalities or comorbidities,postmenopausal women or well-controlled diabetic female patients.[1]
- The decision to use antimicrobials should be case based, in other words it should depend on the patients specifics like allergy and compliance history, availability and cost of treatment and resistant rates at the local community.
- Being the most common cause of cystitis (75-90%), E.Coli susceptibility should be considered when choosing the appropriate empirical antimicrobial. Other organisms like Proteus mirabilis, Klebsiella pneumoniae and Staphylococcus saprophyticus are less common.
- Nitrofurantoin, Fosfomycin and Mecillinam are prefered as first line treatment because they have less resistance among other antibacterials [2][3]with similar efficacy.[4][5][6][7]
- Nitrofurantoin, Fosfomycin and Mecillinam should not be used when pyelonephritis is suspected, because they have weak penetration to the renal tissue.
- Use of broad-spectrum antimicrobials like Fluoroquinolones have resulted in multidrug resistant organisms,[10]so they are used as alternative to the first line drugs in case of allergy, unavailability or intolerance.[11][12]
- Beta-lactams have less efficacy than Fluoroquinolones. While Ampicillin and Amoxicillin should be avoided due to high rate of resistance.[13][14]
- Post-therapy urine culture is recommended only for pregnant women,[15] multiple early recurrences with the same strain of bacteria and for persistent hematuria.
Acute Uncomplicated Cystitis
- Preferred regimen: Nitrofurantoin monohydrate/macrocrystal 100 mg bid 5 days (avoid if early pyelonephritis suspected) OR Trimethoprim-sulfamethoxazole 160/800 mg (one DS tablet) bid 3 days (avoid if resistance prevalence is known to exceed 20 or if used for UTI in previous 3 months) OR Fosfomycin trometamol 3 gm single dose (lower efficacy than some other recommended agents; avoid if early pyelonephritis suspected) OR Pivmecillinam 400 mg bid 5 days (lower efficacy than some other recommended agents; avoid if early pyelonephritis suspected)
- Alternative regimen (1): Fluoroquinolones, Ofloxacin, Ciprofloxacin, and Levofloxacin, use for 3 days.
- Alternative regimen (2): β-Lactam agents, including Amoxicillin-clavulanate, Cefdinir, Cefaclor, and Cefpodoxime-proxetil, for 3–7-days
Complicated/Catheter Associated cystitis
Cases of Complicated cystitis include: all men with the infection, pregnant women, children with metabolic or anatomical abnoramlities, and all patients with risk of serious complications and/or failure of treatment(stones, obstruction, immunocompromised patients, neurogenic bladder, renal failure,transplant patients) considered as complicated infections[16]
- Urinary infections in catheterized patients tend to be polymicrobial with more resistant uropathogens.
- Urine culture:should be taken before initiation the antimicrobial therapy.[17] For infected patients with indwelling catheters more than 2 weeks, the catheter should be replaced, and urine culture should be sampled from the new catheter to improve the outcome of treatment with less complications.[18]
Duration of Treatment
- The duration of treatment depends on the response to treatment regardless of whether the catheter is still in place. For quick resolution, a 7 days regimen is recommended, while patients with delayed clinical improvement need an extended treatment regimen of 10-14 days.[19]
- For mild catheter-associated UTIs, Levofloxacin for 5 days is recommended. A 3 day regimen of antimicrobials is recommended for women ≤ 65 with lower urinary symptoms only after catheter removal.[20]
Cystitis in Pregnancy
- Urine culture is obtained after completion of antimicrobials regimen.
- Nitrofurantoin and Sulfonamides (category B) are not preferred before delivery. Nitrofurantoin should be avoided when G6PD deficiency is suspected with the fetus due to the risk of hemolytic anemia.[21] Sulfonamides have been associated with increased unbound bilirubin levels in fetal blood and kernicterus.
- Trimethoprim (category C) is a folic acid antagonist, therefore it is not used in the first trimester to avoid the risk of possible birth defects.[22]
Recurrent Cystitis
Recurrent cystitis suggests antimicrobial resistance.
- When there is recurrence or persistence of urinary symptoms within 1-2 weeks of treatment of uncomplicated cystitis, broad spectrum fluoroquinolones should be initiated after a urine culture.
- Recurrent cystitis that occurs at least one month after successful treatment is treated with a short course (7 days) of first line antimicrobial therapy, .
- Recurrence within 6 month of successful treatment should be treated with another first line agent than the one used first time.[23]
- In postmenopausal women, it's recommended to evaluate correctable factors like cystocele, incontinence and residual urine volume ≥50 ml.
==Empiric Therapy for Acute Cystitis== Adapted from Clin Infect Dis. 2011;52(5):e103-20.[24]
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References
- ↑ Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG; et al. (2011). "International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases". Clin Infect Dis. 52 (5): e103–20. doi:10.1093/cid/ciq257. PMID 21292654.
- ↑ Kahlmeter, G. (2003). "An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO.SENS Project". J Antimicrob Chemother. 51 (1): 69–76. PMID 12493789. Unknown parameter
|month=ignored (help) - ↑ Naber, KG.; Schito, G.; Botto, H.; Palou, J.; Mazzei, T. (2008). "Surveillance study in Europe and Brazil on clinical aspects and Antimicrobial Resistance Epidemiology in Females with Cystitis (ARESC): implications for empiric therapy". Eur Urol. 54 (5): 1164–75. doi:10.1016/j.eururo.2008.05.010. PMID 18511178. Unknown parameter
|month=ignored (help) - ↑ Gupta, K.; Hooton, TM.; Roberts, PL.; Stamm, WE. (2007). "Short-course nitrofurantoin for the treatment of acute uncomplicated cystitis in women". Arch Intern Med. 167 (20): 2207–12. doi:10.1001/archinte.167.20.2207. PMID 17998493. Unknown parameter
|month=ignored (help) - ↑ Iravani, A.; Klimberg, I.; Briefer, C.; Munera, C.; Kowalsky, SF.; Echols, RM. (1999). "A trial comparing low-dose, short-course ciprofloxacin and standard 7 day therapy with co-trimoxazole or nitrofurantoin in the treatment of uncomplicated urinary tract infection". J Antimicrob Chemother. 43 Suppl A: 67–75. PMID 10225575. Unknown parameter
|month=ignored (help) - ↑ Stein, GE. (1999). "Comparison of single-dose fosfomycin and a 7-day course of nitrofurantoin in female patients with uncomplicated urinary tract infection". Clin Ther. 21 (11): 1864–72. doi:10.1016/S0149-2918(00)86734-X. PMID 10890258. Unknown parameter
|month=ignored (help) - ↑ Minassian, MA.; Lewis, DA.; Chattopadhyay, D.; Bovill, B.; Duckworth, GJ.; Williams, JD. (1998). "A comparison between single-dose fosfomycin trometamol (Monuril) and a 5-day course of trimethoprim in the treatment of uncomplicated lower urinary tract infection in women". Int J Antimicrob Agents. 10 (1): 39–47. PMID 9624542. Unknown parameter
|month=ignored (help) - ↑ Gupta, K. (2003). "Emerging antibiotic resistance in urinary tract pathogens". Infect Dis Clin North Am. 17 (2): 243–59. PMID 12848469. Unknown parameter
|month=ignored (help) - ↑ Raz, R.; Chazan, B.; Kennes, Y.; Colodner, R.; Rottensterich, E.; Dan, M.; Lavi, I.; Stamm, W. (2002). "Empiric use of trimethoprim-sulfamethoxazole (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. 34 (9): 1165–9. doi:10.1086/339812. PMID 11941541. Unknown parameter
|month=ignored (help) - ↑ Hooton, TM.; Besser, R.; Foxman, B.; Fritsche, TR.; Nicolle, LE. (2004). "Acute uncomplicated cystitis in an era of increasing antibiotic resistance: a proposed approach to empirical therapy". Clin Infect Dis. 39 (1): 75–80. doi:10.1086/422145. PMID 15206056. Unknown parameter
|month=ignored (help) - ↑ Paterson, DL. (2004). "Collateral damage from cephalosporin or quinolone antibiotic therapy". Clin Infect Dis. 38 Suppl 4: S341–5. doi:10.1086/382690. PMID 15127367. Unknown parameter
|month=ignored (help) - ↑ Ramphal, R.; Ambrose, PG. (2006). "Extended-spectrum beta-lactamases and clinical outcomes: current data". Clin Infect Dis. 42 Suppl 4: S164–72. doi:10.1086/500663. PMID 16544267. Unknown parameter
|month=ignored (help) - ↑ Rodríguez-Baño, J.; Alcalá, JC.; Cisneros, JM.; Grill, F.; Oliver, A.; Horcajada, JP.; Tórtola, T.; Mirelis, B.; Navarro, G. (2008). "Community infections caused by extended-spectrum beta-lactamase-producing Escherichia coli". Arch Intern Med. 168 (17): 1897–902. doi:10.1001/archinte.168.17.1897. PMID 18809817. Unknown parameter
|month=ignored (help) - ↑ Hooton, TM.; Scholes, D.; Gupta, K.; Stapleton, AE.; Roberts, PL.; Stamm, WE. (2005). "Amoxicillin-clavulanate vs ciprofloxacin for the treatment of uncomplicated cystitis in women: a randomized trial". JAMA. 293 (8): 949–55. doi:10.1001/jama.293.8.949. PMID 15728165. Unknown parameter
|month=ignored (help) - ↑ Nicolle, LE.; Bradley, S.; Colgan, R.; Rice, JC.; Schaeffer, A.; Hooton, TM. (2005). "Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults". Clin Infect Dis. 40 (5): 643–54. doi:10.1086/427507. PMID 15714408. Unknown parameter
|month=ignored (help) - ↑ Hooton, TM. (2012). "Clinical practice. Uncomplicated urinary tract infection". N Engl J Med. 366 (11): 1028–37. doi:10.1056/NEJMcp1104429. PMID 22417256. Unknown parameter
|month=ignored (help) - ↑ Nicolle, LE. (2001). "A practical guide to antimicrobial management of complicated urinary tract infection". Drugs Aging. 18 (4): 243–54. PMID 11341472.
- ↑ Raz, R.; Schiller, D.; Nicolle, LE. (2000). "Chronic indwelling catheter replacement before antimicrobial therapy for symptomatic urinary tract infection". J Urol. 164 (4): 1254–8. PMID 10992375. Unknown parameter
|month=ignored (help) - ↑ "The prevention and management of urinary tract infections among people with spinal cord injuries. National Institute on Disability and Rehabilitation Research Consensus Statement. January 27-29, 1992". J Am Paraplegia Soc. 15 (3): 194–204. 1992. PMID 1500945. Unknown parameter
|month=ignored (help) - ↑ Mohler, JL.; Cowen, DL.; Flanigan, RC. (1987). "Suppression and treatment of urinary tract infection in patients with an intermittently catheterized neurogenic bladder". J Urol. 138 (2): 336–40. PMID 3496470. Unknown parameter
|month=ignored (help) - ↑ Ben David, S.; Einarson, T.; Ben David, Y.; Nulman, I.; Pastuszak, A.; Koren, G. (1995). "The safety of nitrofurantoin during the first trimester of pregnancy: meta-analysis". Fundam Clin Pharmacol. 9 (5): 503–7. PMID 8617414.
- ↑ Crider, KS.; Cleves, MA.; Reefhuis, J.; Berry, RJ.; Hobbs, CA.; Hu, DJ. (2009). "Antibacterial medication use during pregnancy and risk of birth defects: National Birth Defects Prevention Study". Arch Pediatr Adolesc Med. 163 (11): 978–85. doi:10.1001/archpediatrics.2009.188. PMID 19884587. Unknown parameter
|month=ignored (help) - ↑ Hooton, TM. (2012). "Clinical practice. Uncomplicated urinary tract infection". N Engl J Med. 366 (11): 1028–37. doi:10.1056/NEJMcp1104429. PMID 22417256. Unknown parameter
|month=ignored (help) - ↑ Gupta, K.; Hooton, TM.; Naber, KG.; Wullt, B.; Colgan, R.; Miller, LG.; Moran, GJ.; Nicolle, LE.; Raz, R. (2011). "International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases". Clin Infect Dis. 52 (5): e103–20. doi:10.1093/cid/ciq257. PMID 21292654. Unknown parameter
|month=ignored (help)