Kranz Jennifer, Schmidt Stefanie, Lebert Cordula, Schneidewind Laila, Mandraka Falitsa, Kunze Mirjam, Helbig Sina, Vahlensieck Winfried, Naber Kurt, Schmiemann Guido, Wagenlehner Florian M
Department of Urology and Paediatric Urology, St. Antonius Hospital, Eschweiler, Germany.
UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany.
Urol Int. 2018;100(3):271-278. doi: 10.1159/000487645. Epub 2018 Mar 14.
We aimed to update the 2010 evidence- and consensus-based national clinical guideline on the diagnosis and management of uncomplicated urinary tract infections (UTIs) in adult patients. Results are published in 2 parts. Part 1 covers methods, the definition of patient groups, and diagnostics. This second publication focuses on treatment of acute episodes of cystitis and pyelonephritis as well as on prophylaxis of recurrent UTIs.
An interdisciplinary group consisting of 17 representatives of 12 medical societies and a patient representative was formed. Systematic literature searches were conducted in MEDLINE, EMBASE, and the Cochrane Library to identify literature published in 2010-2015.
For the treatment of acute uncomplicated cystitis (AUC), fosfomycin-trometamol, nitrofurantoin, nitroxoline, pivmecillinam, and trimethoprim (depending on the local rate of resistance) are all equally recommended. Cotrimoxazole, fluoroquinolones, and cephalosporins are not recommended as antibiotics of first choice, for concern of an unfavorable impact on the microbiome. Mild to moderate uncomplicated pyelonephritis should be treated with oral cefpodoxime, ceftibuten, ciprofloxacin, or levofloxacin. For AUC with mild to moderate symptoms, instead of antibiotics symptomatic treatment alone may be considered depending on patient preference after discussing adverse events and outcomes. Primarily non-antibiotic options are recommended for prophylaxis of recurrent urinary tract infection.
In accordance with the global antibiotic stewardship initiative and considering new insights in scientific research, we updated our German clinical UTI guideline to promote a responsible antibiotic use and to give clear hands-on recommendations for the diagnosis and management of UTIs in adults in Germany for healthcare providers and patients.
我们旨在更新2010年基于证据和共识制定的关于成年患者单纯性尿路感染（UTIs）诊断和管理的国家临床指南。结果分两部分发表。第1部分涵盖方法、患者群体定义和诊断。本第二篇出版物聚焦于膀胱炎和肾盂肾炎急性发作的治疗以及复发性UTIs的预防。
成立了一个由12个医学协会的17名代表和一名患者代表组成的跨学科小组。在MEDLINE、EMBASE和Cochrane图书馆进行了系统的文献检索，以识别2010 - 2015年发表的文献。
对于急性单纯性膀胱炎（AUC）的治疗，磷霉素氨丁三醇、呋喃妥因、硝恶啉、匹美西林和甲氧苄啶（取决于当地耐药率）均同样被推荐。复方新诺明、氟喹诺酮类和头孢菌素类不被推荐作为首选抗生素，因为担心对微生物群有不利影响。轻度至中度单纯性肾盂肾炎应用口服头孢泊肟、头孢布烯、环丙沙星或左氧氟沙星治疗。对于有轻度至中度症状的AUC，在讨论不良事件和结局后，根据患者偏好，可考虑仅进行对症治疗而非使用抗生素。复发性尿路感染的预防主要推荐非抗生素选择。
根据全球抗生素管理倡议并考虑到科学研究的新见解，我们更新了德国临床UTI指南，以促进合理使用抗生素，并为德国医疗保健提供者和患者提供关于成年患者UTIs诊断和管理的明确实用建议。
