Overview: Managing Acute Uncomplicated Urinary Tract Infections
The full newsletter Managing Acute Uncomplicated Urinary Tract Infections, prescribing information and CME self-assessment are free for both AMA members and nonmembers.
Urinary tract infections (UTIs) are common reasons for adults to seek ambulatory care in the United States. UTI is classified as complicated or uncomplicated in order to define management approaches, including whether or not definitive diagnostic testing is needed, the choice of empiric antimicrobial agents, and follow-up testing or other clinical interventions. Acute uncomplicated UTI includes bladder infection, or acute uncomplicated cystitis (AUC) and acute uncomplicated pyelonephritis (AUP). Women are disproportionally affected by UTI, comprising approximately 85% of annual visits for this condition. The burden of UTI is increased by rates of AUC recurrence among younger, healthy women reported as high as 25% in the six months after the first UTI, and a substantial proportion of these women continue to experience recurrences throughout the life span.
Escherichia coli cause 80%-90% of uncomplicated UTIs in young, otherwise healthy, sexually active women, and a significant proportion of complicated UTIs. A subset of extra intestinal E. coli are epidemiologically linked to UTI and most adapted to virulence and fitness in the urinary tract. Epidemiological studies of sporadic or recurrent AUC or AUP among healthy women consistently yield several clinical risk factors for these infections, including a history of previous UTI, use of spermicides for contraception, sexual intercourse, a history of UTI in a first-degree female relative, and a new sexual partner within the last year. The differential diagnosis of UTI includes urethritis, cervicitis, and vaginitis, as these infections may also cause dysuria, and sexually transmitted causes of these infections are also associated with a new sexual partner
Guidelines for treatment have been promulgated by the Infectious Diseases Society of America (IDSA). The IDSA guidelines address the treatment of premenopausal, nonpregnant women with no known urological abnormalities or comorbidities. The antibiotics recommended for empirical treatment of UTI are influenced by the likelihood of inducing adverse effects in patients or adverse ecological effects upon bacteria by promoting the development of drug-resistant pathogens. Recommended first-line therapies in the United States include trimethoprim- sulfamethoxasole, nitrofurantoin monohydrate crystals, or fosfomycin trometamol. Fluoroquinolones are recommended as second-line therapy unless local resistance rates for trimethoprim-sulfamethoxazole exceed 20%. National prescribing data reveal significant variations in practice from these recommendations.
In Managing Acute Uncomplicated Urinary Tract Infections physicians will learn to:
- Describe the typical pathophysiology and clinical syndrome comprising uncomplicated urinary tract infection.
- Explain complicating and clinical risk factors for urinary tract infections.
- Implement strategies for the appropriate diagnosis of acute uncomplicated cystitis and pyelonephritis in women.
- Compare his/her current approach to treatment at the national level with professional guideline recommendations.
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