Guidelines for antimicrobial treatment and prophylaxis of urinary tract infections – year 2006

Abstract

Preporuke za antimikrobno liječenje i profilaksu infekcija mokraćnog sustava (IMS) donešene su prema rezultatima ispitivanja rezistencije najčešćih uzročnika IMS na antimikrobike što ga od 1997. godine provodi Odbor za praćenje rezistencije bakterija na antibiotike u Republici Hrvatskoj. Nekomplicirani cistitis liječi se 1, 3 ili 7 dana, komplicirani cistitis 7 dana, pijelonefritis 10–14 dana, a komplicirane IMS 7 do 14 dana, rijetko duže. U liječenju cistitisa rabe se fluorokinoloni, nitrofurantoin, betalaktamski antibiotici te u područjima niže rezistencije trimetoprim/sulfametoksazol. Jednokratna terapija fluorokinolonima primjenjuje se u inače zdravih mladih žena s normalnim urotraktom u kojih su simptomi cistitisa prisutni kraće od 7 dana. Empirijska antimikrobna terapija pijelonefritisa, rekurentnih i svih kompliciranih IMS treba se revidirati nakon nalaza urinokulture. U liječenju bakterijskog prostatitisa i febrilnih IMS muškaraca lijek prvog izbora je ciprofloksacin. Asimptomatska bakteriurija (AB) liječi se u trudnica, novorođenčadi, predškolske djece s abnormalnim urotraktom, prije invazivnih uroloških i ginekoloških zahvata, u primaoca transplantiranog bubrega, u prvim danima kratkotrajne kateterizacije mokraćnog mjehura. Antimikrobna profilaksa primjenjuje se prvenstveno jedan sat prije dijagnostičkog ili terapijskog invazivnog urološkog postupka odabranim antimikrobnim sredstvima.Recommendations for antimicrobial treatment and prophylaxis of urinary tract infections (UTI) have been made according to study results on the resistance of the most frequent causative agents of UTI to antimicrobial drugs. The Committee for monitoring bacterial resistance to antibiotics in the Republic of Croatia has been conducting this study since 1997. Uncomplicated cystitis is treated for 1, 3 or 7 days, complicated cystitis for 7 days, pyelonephritis 10–14 days, and complicated UTI 7 to 14 days, rarely longer. For the treatment of cystitis the following drugs are used: fluoroquinolones, nitrofurantoin, betalactam antibiotics, and in cases of lower resistance trimethoprim-sulfamethoxazole. A single therapy with fluoroquinolones is administered to otherwise healthy young women with normal urinary tract in whom cystitis symptoms have been present for less than 7 days. Empirical antimicrobial therapy of pyelonephritis, recurrent and all complicated UTIs must be reviewed after urine culture finding is obtained. In the treatment of bacterial prostatitis and febrile UTIs in males, the drug of first choice is ciprofloxacin. Asymptomatic bacteriuria is treated in pregnant women, newborns, preschool children with urinary tract abnormalities, before invasive urological and gynecological procedures, in kidney transplant recipients, and in the first days of short-term urinary bladder catheterization. Antimicrobial prophylaxis is administered primarily one hour prior to diagnostic or therapeutic invasive urological procedures, using selected antimicrobial agents