The role of antibiotics in the treatment of chronic prostatitis: A consensus statement

Practical guidelines for the diagnosis and treatment of chronic prostatitis are presented. Chronic prostatitis is classified as chronic bacterial prostatitis (culture-positive) and chronic inflammatory prostatitis (culture-negative). If chronic bacterial prostatitis is suspected, based on relevant symptoms or recurrent UTIs, underlying urological conditions should be excluded by the following tests: rectal examination, midstream urine culture and residual urine. The diagnosis should be confirmed by the Meares and Stamey technique. Antibiotic therapy is recommended for acute exacerbations of chronic prostatitis, chronic bacterial prostatitis and chronic inflammatory prostatitis, if there is clinical, bacteriological or supporting immunological evidence of prostate infection. Unless a patient presents with fever, antibiotic treatment should not be initiated immediately except in cases of acute prostatitis or acute episodes in a patient with chronic bacterial prostatitis. The work-up, with the appropriate investigations should be done first, within a reasonable time period which, preferably, should not be longer than 1 week. During this period, nonspecific treatment, such as appropriate analgesia to relieve symptoms, should be given. The minimum duration of antibiotic treatment should be 2-4 weeks. If there is no improvement in symptoms, treatment should be stopped and reconsidered. However, if there is improvement, it should be continued for at least a further 2-4 weeks to achieve clinical cure and, hopefully, eradication of the causative pathogen. Antibiotic treatment should not be given for 6-8 weeks without an appraisal of its effectiveness. Currently used antibiotics are reviewed. Of these, the fluoroquinolones ofloxacin and ciprofloxacin are recommended because of their favourable antibacterial spectrum and pharmacokinetic profile. A number of clinical trials are recommended and a standard study design is proposed to help resolve some outstanding issues

Fosfomycin Trometamol in Patients with Renal Insufficiency and in the Elderly

Single oral dose therapy with fosfomycin trometamol (FT) 3 g is recommended inthe treatment of uncomplicated urinary tract infection (UTI) not only in premenopausal,but also in postmenopausal elderly, otherwise healthy women. It can alsobe used as reapplication every 10 days for prophylaxis of recurrent uncomplicatedcystitis. FT 3 g has also been used with two oral doses of 3 g (on two consecutivedays) for perioperative prophylaxis in transurethral interventions or with three doses(every other day, three times) for treatment of complicated lower UTI includingmany elderly patients. The tolerance and safety in the patients above 65 yearsof age did not differ from younger ones. Therefore, there is also an indication toadminister oral FT 3g in adults above 65 years of age for treatment or prophylaxisof uncomplicated UTI.Patients with renal insufficiency up to a creatinine clearance of 20 ml/min can beexpected to have still sufficiently high urinary concentrations of fosfomycin, thattreatment of cystitis should be justified from pharmacokinetic/pharmacodynamicpoint of view. From preliminary clinical results there is also an indication to useoral FT 3 g in adults with renal insufficiency up to a creatinine clearance of 20 ml/min, with single dose for treatment of lower uncomplicated UTI with otherwisenormal urinary tract or with repeated doses (every second or third day accordingto the degree of renal insufficiency) for treatment of lower complicated UTI causedby fosfomycin susceptible pathogens resistant to other oral antimicrobial drugs

Diagnosis of acute cystitis in primary care: symptom-based versus urinalysis-based diagnosis

AIM: This study aimed to provide insight into the congruity of acute cystitis (AC) diagnosis in women, measured both by the Acute Cystitis Symptom Score (ACSS) questionnaire and urine test(s). BACKGROUND: The ACSS questionnaire was developed as a self-administering tool for assessing urinary symptoms, quality of life (QoL) and treatment outcomes in healthy, nonpregnant female patients. METHODS: This prospective observational cohort study compared AC diagnosis based on the questionnaire with a GP diagnosis based on dipstick/dipslide test(s). ACSS questionnaire form A (typical and differential symptoms, QoL and relevant conditions) was filled in by the patient group, women suspected for AC visiting a GP practice with a urine sample, and the reference group, women visiting a community pharmacy for any medication. Analyses were performed assuming that the GP diagnosis based on urine test(s) was correct. Divergent result(s) of urine test(s) and ACSS questionnaire were analysed for scores of all individual questionnaire domains. Statistical analyses included descriptive statistics and the positive predictive value (PPV) and the negative predictive value (NPV) of the ACSS questionnaire and the urine test(s). FINDINGS: In the patient group, 59 women were included, 38 of whom a GP positively diagnosed for AC. The reference group included 70 women. The PPV of the ACSS questionnaire was 77.3%, and the NPV was 73.3%. Analysis of patient data for divergent results showed that differential symptoms, QoL and relevant conditions explained false-positive and false-negative results. Revised results (most probable diagnosis) based on this analysis showed a PPV and NPV of 88.6% and 73.3% for the ACSS questionnaire and 100% and 76.2% for the urine test(s). For use in primary care, a reduction in false-positive and false-negative results can be achieved by including scores for differential symptoms, QoL and relevant conditions, alongside a total typical symptoms score of 6 or higher

Validation of the Spanish Acute Cystitis Symptoms Score (ACSS) in native Spanish‐speaking women of Europe and Latin America

Introduction and Objectives The Acute Cystitis Symptom Score (ACSS) is a patient self-reporting questionnaire for clinical diagnostics and patient-reported outcome (PRO), which may assess the symptoms and the effect on the quality of life in women with acute cystitis (AC). The current study aimed to create a validated Spanish version of the ACSS questionnaire. Material and Methods The process of linguistic validation of the Spanish version of the ACSS consisted of the independent forward and backward translations, revision and reconciliation, and cognitive assessment. Clinical evaluation of the study version of the ACSS was carried out in clinics in Spain and Latin America. Statistical tests included the calculation of Cronbach's α, split-half reliability, specificity, sensitivity, diagnostic odds ratio, positive and negative likelihood ratio, and area under the receiver-operating characteristic curve (AUC). Results The study was performed on 132 patients [age (mean;SD) 45.0;17.8 years] with AC and 55 controls (44.5;12.2 years). Cronbach's α of the ACSS was 0.86, and the split-half reliability was 0.82. The summary scores of the ACSS domains were significantly higher in patients than in controls, 16.0 and 2.0 (p < 0.001), respectively. The predefined cut-off point of ≥6 for a summary score of the “Typical” domain resulted in a specificity of 83.6% and a sensitivity of 99.2% for the Spanish version of the ACSS. AUC was 0.91 [0.85; 0.97]. Conclusions The validated Spanish ACSS questionnaire evaluates the symptoms and clinical outcomes of patients with AC. It can be used as a patient's self-diagnosis of AC, as a PRO measure tool, and help to rule out other pathologies in patients with voiding syndrome

Noi aspecte în diagnosticul și tratamentul ITU necomplicate

Technical University of Munich, Munich, Germany, Al VII-lea Congres de Urologie, Dializã si Transplant Renal din Republica Moldova cu participare internațională 19-21 iunie 2019Acute uncomplicated cystitis (AC) in women is one of the most frequently diagnosed bacterial infection. A symptomatic urinary tract infection (UTI) must be differenciated from asymptomatic bacteriuria (ABU), which in general should not be treated and even may be protective sometimes. For therapy of AC old oral antibiotics (fosfomycin, nitrofurantoin, nitroxoline, pivmecillinam) should be prescribed. Fluoroquinolones, cephalosporines, and cotrimoxazole should only be used if first line antibiotics are not available or not suitable. With new therapeutic concepts not mainly elimination of bacteria but rather treatment of the inflammatory (over)reaction of the host is highlighted. Pilot studies with ibuprofen and with the phytodrug containing ingredients of centaury, lovage, and rosemary (Canephron®N) have demonstrated proof of this concept. To establish the significance of these therapeutic alternatives, results of phase 3 studies need to be awaited. If symptomatic therapy becomes more important, reliable clinical parameters are needed. The acute cystitis symptom score (ACSS) has now been validated in Uzbek, Russian and German languages; other languages will follow. Because of its high reliability, validity and predictive value the ACSS can be used not only in daily practice but also in clinical studies for diagnosis and outcome of AC in women.Cistita acută necomplicată (CA) la femei este una dintre cel mai frecvent diagnosticate infecții bacteriene. O infecție de tract urinar simptomatică (ITU) trebuie să fie diferențiată de bacteriuria asimptomatică (BUA), care, în general, nu trebuie tratată sau poate avea chiar efect protectiv. Pentru tratamentul CA trebuie prescrise antibiotice orale de primă linie (fosfomicină, nitrofurantoină, nitroxolină, pivmecilină). Fluorchinolonele, cefalosporinele și co-trimoxazolul trebuie să fie utilizate dacă antbioticele de primă linie nu sunt disponibile sau sunt nepotrivite. Noul concept terapeutic presupune nu doar eliminarea bacteriei patogene, dar este focusat mai ales pe tratarea reacției inflamatorii a gazdei. Studiile pilot cu ibuprofen și fitopreparate care conțin ingrediente de dioc, leuștean și rozmarin (Canephron®N) au demonstrat eficacitatea acestui concept. Pentru a stabili importanța acestor alternative terapeutice sunt necesare rezultatele studiilor de fază 3. Dacă terapia simptomatică devine mai importantă sunt necesari parametri clinici siguri. Scorul „acute cystitis symptom score” (ACSS) a fost validat în limbile uzbecă, rusă și germană; alte limbi vor urma. Din cauza fiabilității, validității și valorii predictive înalte, ACSS poate fi utilizat nu doar în practica zilnică, dar și în studii clinice, pentru diagnostic și aprecierea rezultatelor tratamentului CA la femei

Antibiotic treatment of uncomplicated urinary tract infection in premenopausal women

Uncomplicated urinary tract infections (UTIs) in otherwise healthy premenopausal women are one of the most frequent infections in the community. Therefore any improvement in management will have a high impact not only on the quality of life of the individual patient but also on the health system. In placebo-controlled studies antimicrobial treatment was significantly more effective than placebo, but on the other hand showed more adverse events. The choice of antibiotic depends on the spectrum and susceptibility patterns of the uropathogens, its effectiveness for this indication, its tolerability, its collateral effects and cost. After a systematic literature search, recommendations for empiric treatment of acute uncomplicated cystitis and acute uncomplicated pyelonephritis and for follow-up strategies were developed. (C) 2011 Elsevier B. V. and the International Society of Chemotherapy. All rights reserved

Antibiotics and Urinary Tract Infections

Urinary tract infections (UTI) are one of the most frequently occurring infections, not only community acquired, but also hospital acquired infections. An increase of resistant uropathogens against commonly used antibiotics can be observed worldwide, a subject of great concern. Several strategies are discussed how to cope with this problem: i) not to use antibiotics, when not indicated, e.g. asymptomatic bacteriuria, or when non-antimicrobial measures are available, e.g. for prophylaxis of recurrent UTI; ii) to prefer even old antibiotics, which still have preserved their antibacterial activity against uropathogens; iii) if broad spectrum antibiotics are needed for empiric therapy of severe infections, to use the right and high enough dosages to reduce selection of resistant pathogens, and to step down to a more tailored antibiotic therapy as soon as possible; iv) to control and try to avoid health care associated UTI by optimal hygienic and interventional strategies; and last but not least v) to stimulate development of new antibiotics, especially when new bacterial targets can be approache