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Urologe A. 2017 Jun;56(6):746-758. doi: 10.1007/s00120-017-0389-1.

[Epidemiology, diagnostics, therapy, prevention and management of uncomplicated bacterial outpatient acquired urinary tract infections in adult patients : Update 2017 of the interdisciplinary AWMF S3 guideline].

[Article in German]

Author information

1
Klinik für Urologie und Kinderurologie, St. Antonius-Hospital, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland. jennifer.kranz@sah-eschweiler.de.
2
UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Deutschland. jennifer.kranz@sah-eschweiler.de.
3
UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Deutschland.
4
Apotheke, Klinikum Nürnberg, Nürnberg, Deutschland.
5
Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg Saar, Deutschland.
6
Fachklinik für Urologie, Kurparkklinik, Bad Nauheim, Deutschland.
7
Innere Medizin IV, Universitätsklinikum des Saarlandes, Bad Homburg, Deutschland.
8
Klinik für Innere Medizin I, Sophien- und Hufeland-Klinikum GmbH, Weimar, Deutschland.
9
Klinische Infektiologie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland.
10
Department Klinische Chemie, Städtisches Klinikum München, München, Deutschland.
11
Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland.
12
Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland.
13
Abteilung für Mikrobiologie und Krankenhaushygiene, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland.
14
Urologische Klinik, Technische Universität, München, Deutschland.
15
Klinische Infektiologie, Labor Dr. Wisplinghoff, Köln, Deutschland.
16
ICA-Deutschland e.V., Förderverein Interstitielle Zystitis (ICA), Euskirchen, Deutschland.
17
Institut für Public Health und Pflegeforschung, Versorgungsforschung, Universität Bremen, Bremen, Deutschland.
18
Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Universitätsklinikum Giessen und Marburg GmbH, Justus-Liebig-Universität Giessen, Giessen, Deutschland.

Abstract

BACKGROUND:

Update of the 2010 published evidence-based S3 guideline on epidemiology, diagnostics, therapy and management of uncomplicated, bacterial, outpatient-acquired urinary tract infections in adult patients. The guideline contains current evidence for the rational use of antimicrobial substances, avoidance of inappropriate use of certain antibiotic classes and development of resistance.

METHODOLOGY:

The update was created under the leadership of the German Association of Urology (DGU). A systematic literature search was conducted for the period 01 January 2008 to 31 December 2015. International guidelines have also been taken into account. Evidence level and risk of bias were used for quality review.

RESULTS:

Updated information on bacterial susceptibility, success, collateral damage and safety of first- and second-line antibiotics was given. For the treatment of uncomplicated cystitis the first line antibiotics are fosfomycin trometamol, nitrofurantoin, nitroxoline, pivmecillinam, trimethoprim (with consideration of the local resistance rates). Fluoroquinolones and cephalosporins should not be used as first choice antibiotics. In the case of uncomplicated pyelonephritis of mild to moderate forms, preferably cefpodoxime, ceftibuten, ciprofloxacin or levofloxacin should be used as oral antibiotics.

CONCLUSION:

The updated German S3 guideline provides comprehensive evidence- and consensus-based recommendations on epidemiology, diagnostics, therapy, prevention and management of uncomplicated bacterial outpatient acquired urinary tract infections in adult patients. Antibiotic stewardship aspects have significantly influenced the therapeutic recommendations. A broad implementation in all clinical practice settings is necessary to ensure a foresighted antibiotic policy and thus t improve clinical care.

KEYWORDS:

AWMF S3-guideline; Antibiotic resistance; Prevention antibiotic stewardship; Treatment recommendations; Urinary tract infections

PMID:
28455578
DOI:
10.1007/s00120-017-0389-1
[Indexed for MEDLINE]

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