ИНФЕКЦИИ НИЖНИХ МОЧЕВЫХ ПУТЕЙ (ЦИСТИТ, БАКТЕРИУРИЯ) В АМБУЛАТОРНОЙ ПРАКТИКЕ: ИЗМЕНЕНИЕ СТРАТЕГИИ И ТАКТИКИ ЭМПИРИЧЕСКОЙ АНТИМИКРОБНОЙ ТЕРАПИИ (НОВЫЕ КЛИНИЧЕСКИЕ РЕКОМЕНДАЦИИ)

Abstract

Abstract. Introduction. When treating urinary tract infections, especially lower urinary tract cystitis and asymptomatic bacteriuria, quite a few factors have to be considered, such as first episode of cystitis or recurrence, presence of pregnancy or lactation, suspected pathogen and its sensitivity/resistance to antimicrobial agents in the region, recent antibiotic treatment and many others. One such factor that determines disease outcome is the rational choice of empirical antimicrobial therapy. The results of domestic and foreign epidemiological studies indicate a global increase in resistance of uropathogens to antibiotics, which has influenced the change of modern strategy and tactics of antimicrobial therapy. Aim. To review current data on the results of epidemiological and clinical studies and substantiate clinical recommendations for rational empirical therapy of uncomplicated lower urinary tract infections. Material and methods. The original epidemiological and clinical studies in the foreign and domestic literature and clinical guidelines on the topic for the last 5 years were searched. Results and its discussion. Data from epidemiological studies of community-acquired urinary tract infections in the Russian Federation show decreasing sensitivity and increasing resistance among outpatient strains of uropathogenic E. coli and Klebsiella pneumoniae to antibiotics commonly used in outpatient practice: fluoroquinolones, betalactams (including protected ones), cephalosporins, trimethoprim/sulfamethoxazole. which was a prerequisite for limiting the use of many antibiotics widely used in the treatment of urinary tract infections in the last decade. The findings were the basis for changes in the strategy and tactics of empirical antimicrobial therapy, in particular to the exclusion of quinolones/fluoroquinolones and restriction of betalactams from the treatment of uncomplicated cystitis. This review presents indications for a rational choice of empirical antimicrobial therapy for acute and recurrent cystitis and asymptomatic bacteriuria: recommended regimens, doses and duration of therapy. Conclusion. The decision to prescribe antibiotic therapy for lower urinary tract infections should be made after ineffectiveness and non-antimicrobial prophylaxis, and the choice of antibiotic should be based on its environmental safety and prevention of global antimicrobial resistance buildup.