MP23-08 LACK OF UNIFORMITY AMONG UNITED STATES GUIDELINES FOR DIAGNOSIS & MANAGEMENT OF ACUTE, UNCOMPLICATED CYSTITIS

Abstract

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder II1 Apr 2018MP23-08 LACK OF UNIFORMITY AMONG UNITED STATES GUIDELINES FOR DIAGNOSIS & MANAGEMENT OF ACUTE, UNCOMPLICATED CYSTITIS Lauren N. Wood, Andrew R. Medendorp, Melissa Markowitz, Shlomo Raz, David A. Haake, and Ja-Hong Kim Lauren N. WoodLauren N. Wood More articles by this author , Andrew R. MedendorpAndrew R. Medendorp More articles by this author , Melissa MarkowitzMelissa Markowitz More articles by this author , Shlomo RazShlomo Raz More articles by this author , David A. HaakeDavid A. Haake More articles by this author , and Ja-Hong KimJa-Hong Kim More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.740AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Acute, uncomplicated urinary tract infection (UTI) remains one of the most common bacterial infections seen in inpatient and outpatient clinical settings in the United States. Since uncomplicated UTI is treated in a variety of different settings, guidelines from professional medical societies are expected to be well aligned. Our aim was to compare guidelines for diagnosis and treatment of acute, uncomplicated UTI from medical specialties in the U.S. and confirm uniformity. METHODS The most up to date published guidelines within the fields of family medicine, obstetrics & gynecology, internal medicine, female pelvic medicine & reconstructive surgery, and infectious diseases in the U.S. were reviewed. RESULTS All guidelines recommended the use of symptoms and urine dipstick only to diagnose uncomplicated UTI. Some societies did not recommend urine dipstick in cases of recurrent UTI or for patients with classic UTI symptoms with no underlying conditions or competing diagnoses. None recommend the use of urine culture to confirm diagnosis. All guidelines endorsed nitrofurantoin, trimethoprim-sulfamethoxazole, and fosfomycin as first-line agents. Discrepancies existed in the classification of fluoroquinolone and beta-lactam antimicrobials, with most guidelines describing them as second-line, while others considered them first or third-line agents. Amoxicillin and ampicillin, antibiotic agents with high resistance rates in the U.S., were described as important to avoid only by some U.S. guidelines. None mentioned the FDA black box warning for Cipro. (Table available for presentation). CONCLUSIONS Comparison of guidelines from various specialties revealed important differences in the approach to the treatment of acute, uncomplicated UTI. This lack of uniformity is likely to contribute to the varying clinical management of patients with UTI, emphasizing the need for more consistent guidelines that may improve physician adherence. With few exceptions, urine culture with sensitivity was not recommended for the diagnosis or treatment of UTI by any of the guidelines reviewed. However, the widespread use of empiric antibiotic therapy for UTI can contribute to growing antibacterial resistance pattern in the U.S. and impede efforts for antibiotic stewardship. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e284 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Lauren N. Wood More articles by this author Andrew R. Medendorp More articles by this author Melissa Markowitz More articles by this author Shlomo Raz More articles by this author David A. Haake More articles by this author Ja-Hong Kim More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...