Different recommendations for empiric first-choice antibiotic treatment of uncomplicated urinary tract infections in Europe

Figures & data

Table I. Recommendations for first choice antibiotic treatment of uUTI in Europe.

	Nitrofurantoin	Pivmecillinam	Trimethoprim	Sulphamethizole	Fluoroquinolone	Fosfomycine/ trometamol	Amoxicillin/ clavulanic acid
Croatia^a	√
Denmark^b		√	√	√
Germany^c	√	√				√
Scotland^d	√		√
Spain^e	√				√	√	√
Sweden^f	√	√

^aSkerk V, Andrasevic AT, Andrasevic S, Susic E, Dzepina AM, Madaric V et al. [ISKRA guidelines on antimicrobial treatment and prophylaxis of urinary tract infections—Croatian national guidelines]. Lijec Vjesn 2009;131(5–6):105–118.

^bIRF, Institut for Rationel Farmakoterapi [internet]. Antibiotika til systemisk brug (Institute for Rational Pharmacotherapy, Antibiotics for Systemic Use). 12-2-2009. [cited 1–5-2012]. Available from: http://www.irf.dk/dk/rekommandationsliste/infektionssygdomme/antibiotika_systemisk_brug/test_sulfonamider_og_trimethoprim_j01e.htm.

Basislisten 2011 [internet]. Basislisten, lægens værktøj til rationel medicinordination. (The Basic list, the doctor’s tool for rational drug prescribing). [cited 3-2-2012]. Available from: https://www.sundhed.dk/content/cms/15/4915_2012-basislisten.pdf

Helweg-Larsen J, Frimodt-Moller N, Nielsen H, Dahl Knudsen J, Holme P. Antibiotika (systemisk brug), baggrundsnotat, 2009. (Antibiotics (systemic use), background notes, 2009). [internet]. [cited 12-9-2009]. Available from: http://www.irf.dk/dk/rekommandationsliste/baggrundsnotater/infektionssygdomme/antibiotika_systemisk_brug.htm#Uro-genitale_infektioner.

Gahrn-Hansen B, Kolmos HJJ. Antibiotikapolitik og behandling af hyppigt forekommende infektioner i almen praksis. (Policy of antibiotics and treatment of common infections in general practice). Institute for Rational Pharmacotherapy. Danish Medicines Agency. 2001;7.

^cWagenlehner FM, Schmiemann G, Hoyme U, Funfstuck R, Hummers-Pradier E, Kaase M et al. Nationale S3-Leitlinie, unkomplizierte harnwegsinfektionen. Empfehlungen zu terapie und management unkomplizierter bakterieller ambulant erworbener harnwegsinfektionen bei erwachsenen patienten. (S3-guideline for uncomplicated urinary tract infections - treatment guidelines compliance). Med Monatsschr Pharm 2011;34(5):164–168.

^dScottish Intercollegiate Guideline Network. Management of suspected bacterial urinary tract infection in adults. A national clinical guideline. 2012; 7–12.

^eRabanaque G, Romera Á, Domingo C, Herrera C, Plana A, Sánchez J. Infecciones del tracto urinario. (Urinary tract infections). Manual de enfermedades infecciones en atención primaria. (Handbook of infectious diseases in primary helth care). Barcelona: 2010:153–181.

^fAndré M, Ahlqvist-Rastad J, Beermann B. Nedre urinvägsinfektion (UVI) hos kvinnor - Behandlingsrekommendation. (Lower urinary tract infection (UTI) in women - Treatment recommendation). Läkemedelsverket 2007;2:8–15.

Table II. Antimicrobial resistance (%) for E. coli in urine samples from patients with urinary tract infections, in six European countries.

	Nitrofurantoin (%)	Pivmecillinam (%)	Fosfomycine (%)	Sulfamethizole (%)	Trimethroprim (%)	Ciprofloxacin (%)	Amoxicillin/ clavulanic acid (%)
Croatia^a (2009)	2	–	–	24*	24*	10	4
Denmark^b (2009)	0–5	4–5	–	35–38	10–28	11	–
Germany^c (2006)	1–2	1–2	< 1	25–26*	25–26*	3–4	1–2
Scotland^d** (2000)	0	1–2	< 1	36	16–17	1–2	3–4
Spain^e (2006)	3–4	4	1–2	32*	32*	23.9	8
Sweden^f (2007)	1	3	1	15*	15*	5–10	25

Notes: * = resistance to trimethroprim/sulfamethizole. – = no data.

^aSkerk V, Andrasevic AT, Andrasevic S, Susic E, Dzepina AM, Madaric V et al. [ISKRA guidelines on antimicrobial treatment and prophylaxis of urinary tract infections—Croatian national guidelines]. Lijec Vjesn 2009;131(5–6):105–118.

^bDanmap 2009 [internet]. Use of antimicrobial agents and occurrence of antimicrobial resistance from food animals, fruits and humans in Denmark. [cited 1–6-2011.] Available from: www.danmap.org. 2009.

IRF, Institut for Rationel Farmakoterapi [internet]. Antibiotika til systemisk brug (Institute for Rational Pharmacotherapy, Antibiotics for Systemic Use).12-2-2009. [cited 1–5-2012]. Available from: http://www.irf.dk/dk/rekommandationsliste/infektionssygdomme/antibiotika_systemisk_brug/test_sulfonamider_og_trimethoprim_j01e.htm.

^cNaber K, Schito G, Botto H, Palou J, Mazzei T. Surveillance study in Europe and Brazil on Clinical Aspects and antimicrobial Resistance Epidemiology in females with cystitis (ARESC): Implications for Empiric Therapy. European Urology 2008:54:1164–1178.

^dKahlmeter G. The ECO.SENS Project: a prospective, multinational, multicentre epidemiological survey of the prevalence and antimicrobial susceptibility of urinary tract pathogens—interim report. J Antimicrob Chemother 2000;46 Suppl 1:15–22.

^eRabanaque G, Romera Á, Domingo C, Herrera C, Plana A, Sánchez J. Infecciones del tracto urinario. (Urinary tract infections). Manual de enfermedades infecciones en atención primaria. (Handbook of infectious diseases in primary helth care). Barcelona: 2010:153–181.

Naber K, Schito G, Botto H, Palou J, Mazzei T. Surveillance study in Europe and Brazil on Clinical Aspects and antimicrobial Resistance Epidemiology in females with cystitis (ARESC): Implications for Empiric Therapy. European Urology 2008:54:1164–1178.

^fAndré M, Ahlqvist-Rastad J, Beermann B. Nedre urinvägsinfektion (UVI) hos kvinnor - Behandlingsrekommendation. (Lower urinary tract infection (UTI) in women - Treatment recommendation). Läkemedelsverket 2007;2:8–15.