van den Broek P J
Leids Universitair Medisch Centrum, afd. Infectieziekten, Postbus 9600, 2300 RC Leiden.
Ned Tijdschr Geneeskd. 2001 Apr 14;145(15):718-20.
In 1999 the Dutch College of General Practitioners (NHG) and the Dutch Institute for Healthcare Improvement (CBO) published revisions of their guidelines on urinary tract infections. Contrary to previous editions, the revised guidelines agree on most points, but not all. To diagnose a urinary tract infection in non-pregnant women with dysuria, the NHG guideline advises a nitrite test and a dip-slide culture if the nitrite test is negative. Although the dip-slide improves the diagnostic accuracy, a considerable number of patients have to wait at least 24 hours before therapy is given. The diagnostic approach of the CBO guideline uses only rapidly available test results, with the consequence that some women are treated despite not having an infection. The NHG guideline advocates the use of amoxicillin or nitrofurantoin for pregnant women. Amoxicillin is a questionable choice given that about 30% of isolates are resistant to it. Nitrofurantoin is in theory a correct choice. However, it is not registered for the treatment of complicated urinary tract infections. In the CBO guideline amoxicillin-clavulanic acid is considered to be sufficiently safe for the treatment of pregnant women because most urinary tract infections occur after the first trimester.
1999年，荷兰全科医生学院（NHG）和荷兰医疗保健改进研究所（CBO）发布了其关于尿路感染指南的修订版。与先前版本不同的是，修订后的指南在大多数方面达成了一致，但并非全部。为诊断有排尿困难的非妊娠女性是否患有尿路感染，NHG指南建议进行亚硝酸盐检测，若亚硝酸盐检测结果为阴性，则进行浸片培养。尽管浸片培养提高了诊断准确性，但相当多的患者在接受治疗前至少要等待24小时。CBO指南的诊断方法仅使用快速可得的检测结果，结果是一些未感染的女性也接受了治疗。NHG指南提倡对孕妇使用阿莫西林或呋喃妥因。考虑到约30%的分离株对阿莫西林耐药，阿莫西林是一个有问题的选择。呋喃妥因理论上是正确的选择。然而，它未被注册用于治疗复杂性尿路感染。在CBO指南中，阿莫西林 - 克拉维酸被认为对孕妇治疗足够安全，因为大多数尿路感染发生在孕中期之后。
