ACE Clinical Guidances (ACGs)

ACE Clinical Guidances (ACGs)

ACGs* provide concise, evidence-based recommendations to inform specific areas of clinical practice and serve as a common starting point nationally for clinical decision-making. ACGs are underpinned by a wide array of considerations contextualised to Singapore, based on best available evidence at the time of development. Each ACG is developed in collaboration with a multidisciplinary group of local experts representing relevant specialties and practice settings. ACGs are not exhaustive of the subject matter and do not replace clinical judgement. 

Registered doctors and pharmacists may claim 1 Continuing Medical Education (CME)/Continuing Professional Education (CPE) point under category 3A for reading each ACG.

*previously known as Appropriate Care Guides
Published on 17 Nov 2023
Last Updated on 17 Nov 2023
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This ACE Clinical Guidance (ACG) highlights the importance of appropriate diagnosis and treatment of urinary tract infections (UTI) to reduce inappropriate antibiotic use. The ACG offers evidence-based recommendations on the treatment of UTI in adults, focusing on uncomplicated acute cystitis and pyelonephritis in healthy, non-pregnant pre-menopausal women. Principles of appropriate selection of antibiotics as well as patient education on antibiotic use and antimicrobial resistance awareness are also highlighted.

Download the PDF below to access the ACG.
Registered doctors and pharmacists may claim 1 Continuing Medical Education (CME)/Continuing Professional Education (CPE) point under category 3A for reading each ACG.

ACG Recommendations
1. Avoid routinely screening for and treating asymptomatic bacteriuria.
2. Diagnose uncomplicated cystitis based on history and presentation in patients with two or more typical signs or symptoms such as dysuria, frequency, urgency, or absence of vaginal discharge.
 3a. Conduct a urine dipstick test to confirm diagnosis of uncomplicated cystitis where there is uncertainty; and
b. Conduct a urine culture and sensitivity test for unresolved or recurrent cystitis. 
4. Suspect uncomplicated pyelonephritis in patients presenting with sudden-onset flank pain or tenderness, particularly when accompanied by other systemic symptoms such as fever, nausea or vomiting.
5. Conduct urine tests (dipstick or microscopy, plus culture and sensitivity) for all patients with suspected uncomplicated pyelonephritis to confirm diagnosis and guide management. 
6. Prescribe nitrofurantoin empirically for uncomplicated cystitis; if nitrofurantoin is not suitable, prescribe amoxicillin-clavulanate or fosfomycin.
7. Prescribe amoxicillin-clavulanate empirically for patients with uncomplicated pyelonephritis and tailor antibiotic choice accordingly when urine culture and sensitivity results are available; if amoxicillin-clavulanate is not suitable, consider cefuroxime as an alternative.
UTI — appropriate diagnosis and antibiotic use for uncomplicated cystitis and pyelonephritis (Nov 2023) UTI – appropriate diagnosis and antibiotic use references (Nov 2023)

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