Guideline-based treatment of urinary tract infections

Abstract

Urinary tract infections (UTIs) are among the most common infections. Especially complicated UTIs have abroad bacterial spectrum, sometimes having high antibiotic resistance rates. The clinical course might be very different and can range from spontaneous cure to fulminant sepsis. Which initial therapy is adequate for which UTI entity and what are the corresponding guidelines recommendations? This is areview of the current S3 guideline urinary tract infection, the guideline parenteral initial therapy of bacterial infections from the Paul Ehrlich Society, the guideline urological infections from the European Association of Urology (EAU) and the guideline on recurrent uncomplicated UTI in women from the American Urological Association (AUA). Adequate antibiotic therapy is based on the stratification into complicated and uncomplicated, as well as upper and lower infections, and on specific risk factors (e.g., urinary tract catheter) that can be classified according to the ORENUC criteria. Based on this classification, the choice for an empirical antibiotic therapy is made. The spectrum of pathogens should therefore be limited in order to use antibiotics with anarrow spectrum of activity and little collateral damage if possible, thus, preventing both the development of resistance and complications. Adequate empirical antibiotic therapy and prophylaxis in line with guidelines is based on the clinical classification and risk factors.