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.
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UTI — appropriate diagnosis and antibiotic use for uncomplicated cystitis and pyelonephritis (Nov 2023)
UTI – appropriate diagnosis and antibiotic use references (Nov 2023)
|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. |
| 3||a. 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. |
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