McQuiston Haslund, Josephine4; Rosborg Dinesen, Marianne4; Nielsen, Anni Brit Sternhagen6; Llor, Carl5; Bjerrum, Lars7
1 Department of Public Health, Department of Public Health, Faculty of Health and Medical Sciences, Københavns Universitet2 Section of General Practice, Department of Public Health, Faculty of Health and Medical Sciences, Københavns Universitet3 Forskningsenheden for Almen Praksis, Eksterne centre, Københavns Universitet4 Afdeling for Almen Medicin, Københavns Universitet5 University Rovira I Virgili, Tarragona, Spain6 Forskningsenheden for Almen Praksis, Eksterne centre, Københavns Universitet7 Section of General Practice, Department of Public Health, Faculty of Health and Medical Sciences, Københavns Universitet
OBJECTIVE: Uncomplicated urinary tract infection (uUTI) is a common reason for antibiotic treatment in primary health care. Due to the increasing prevalence of antibiotic-resistant uropathogens it is crucial to use the most appropriate antibiotics for first-choice empiric treatment of uUTI. Particularly, it is important to avoid antibiotics associated with a high rate of antimicrobial resistance. This study compares national recommendations from six European countries, investigating recommendations for first-choice antibiotic therapy of uUTI. SETTING: General practice in six European countries. METHOD: Searches were undertaken on PubMed, the Cochrane Library databases, Google, and Google Scholar. Recommendations from different geographical regions in Europe were investigated: Northern Europe (Denmark, Sweden), Western Europe (Scotland), Central Europe (Germany), Southern Europe (Spain), and Eastern Europe (Croatia). RESULTS: The six countries recommended seven different antibiotics. Five countries recommended more than one antibiotic as first-choice treatment. Half of the countries recommended antibiotics associated with a high rate (> 10-20%) of resistant E. coli. All countries recommended at least one antibiotic associated with a low (< 5%) resistance rate. DISCUSSION: The differences in first-choice treatment of uUTI could not be explained by differences in local bacterial aetiology or by different patterns of antimicrobial resistance. Despite resistance rates exceeding 10-20%, sulphamethizole, trimethoprim. or fluoroquinolones were recommended in half of the countries. CONCLUSION: Within the European countries there are considerable differences in recommendations for empiric first-choice antibiotic treatment of uUTI. In order to reduce the increasing antimicrobial resistance in Europe, it is important to agree on the most appropriate antibiotics for empiric treatment of uUTI.
Scandinavian Journal of Primary Health Care, 2013, Vol 31, Issue 4, p. 235-240
The Faculty of Health and Medical Sciences; Urinary Tract Infections; General Practice; Guidelines; Antibiotics; antimicrobial resistance; Anti-Bacterial Agents; Drug Resistance, Bacterial; Europe; Humans; Physician's Practice Patterns; Practice Guidelines as Topic; Primary Health Care