Urinary Tract Infection Management

Diagnosis and Treatment

The European Association of Urology recommends first-line treatment of uncomplicated cystitis in women with fosfomycin trometamol 3g single dose, nitrofurantoin 100mg twice daily for 5 days, or pivmecillinam 400mg three times daily for 3-5 days, based on efficacy, tolerability, and favorable resistance patterns in most communities 1
For men with uncomplicated UTI, the European Association of Urology recommends trimethoprim-sulfamethoxazole 160/800mg twice daily for 7 days 1
The European Association of Urology suggests that fluoroquinolones can be prescribed according to local susceptibility patterns for men with uncomplicated UTI 1
For febrile infants with UTIs, the American Academy of Pediatrics recommends treatment for 7-14 days total, using either oral or parenteral route initially based on clinical severity 3, 4

The European Association of Urology recommends vaginal estrogen replacement in postmenopausal women as a non-antimicrobial prevention strategy for recurrent UTIs (strong recommendation) 1
The European Association of Urology suggests immunoactive prophylaxis for all age groups as a non-antimicrobial prevention strategy for recurrent UTIs (strong recommendation) 1
The European Association of Urology recommends methenamine hippurate for women without urinary tract abnormalities as a non-antimicrobial prevention strategy for recurrent UTIs (strong recommendation) 1

The European Association of Urology recommends always obtaining urine culture before treatment in pregnant women 1
The European Association of Urology suggests avoiding trimethoprim in the first trimester and trimethoprim-sulfamethoxazole in the last trimester in pregnant women 1
The American Academy of Pediatrics recommends not treating asymptomatic bacteriuria except in pregnant women or prior to urinary tract procedures 2, 4

The European Association of Urology emphasizes that antimicrobial choice should be guided by spectrum and susceptibility patterns of aetiological pathogens, efficacy for the particular indication in clinical studies, tolerability and adverse reactions, adverse ecological effects, and costs and availability 1
The American Academy of Pediatrics recommends knowing local resistance patterns for E. coli to trimethoprim-sulfamethoxazole and cephalexin, as there is substantial geographic variability 4