Treatment of urinary tract infections in the era of antimicrobial resistance and new antimicrobial agents.

Treatment of urinary tract infections in the era of antimicrobial resistance and new antimicrobial agents. Postgrad Med. 2019 Oct 14;: Authors: Bader MS, Loeb M, Leto D, Brooks AA Abstract Urinary tract infections (UTIs) caused by antibiotic- resistant Gram-negative bacteria are a growing concern due to limited treatment options. Knowledge of the common uropathogens in addition to local susceptibility patterns is essential in determining appropriate empiric antibiotic therapy of UTIs. The recommended first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females is a 5-day course of nitrofurantion, a 3-g single dose of fosfomycin tromethamine, or a 5-day course of pevmecillinam. High rates of resistance for trimethoprim-sulfamethoxazole and ciprofloxacin preclude their use as empiric treatment of UTIs in several communities, particularly if patients who were recently exposed to them or in patients who are at risk of infections with extended-spectrum β-lactamases (ESBLs)- producing Enterobacteriales. Second line options include oral cephalosporines such as cephalexin or cefixime, fluoroquinolones and β-lactams, such as amoxicillin-clavulanate. Current treatment options for UTIs due to AmpC- β -lactamase-producing Enterobacteriales include nitrofurantion, fosfomycin, pevmecillinam, fluoroquinolones, cefepime, piperacillin-tazobactam and carbapenems. Treatment oral options for UT...
Source: Postgraduate Medicine - Category: Internal Medicine Tags: Postgrad Med Source Type: research

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