Urinary tract infections and antibiotics – the debate goes on
Reviewed by Arun K Sharma

A large number of hospital patients and primary care patients suffer from recurrent urinary tract infection (UTI) and urosepsis. Some of these patients end up in intensive care units with multi-organ failure. New draft guidance from the National Institute for Health & Care Excellence (NICE) states the following: 1) Patients should be advised on lifestyle changes and hygiene care, 2) No evidence has been found on the benefits of drinking cranberry juice, 3) In non-pregnant women narrow spectrum antibiotics should be used as first-line treatment e.g. nitrofurantoin or trimethoprim, 4) In lower UTI in pregnant women, back-up antibiotic prescription should be given, while waiting culture reports, 5) One-third of E. coli UTIs show a worrying resistance to common antibiotics, 6) Ideally, antibiotics should only be started after a positive midstream urine sample. Extended-spectrum beta-lactamases (ESBL) organisms are becoming the ‘super-bugs’ of urology. They usually require costly intravenous drugs, pressure on hospital beds and medical / nursing staff time. In everyday practice, microorganisms are showing unexpected and mysterious changes. We need to stay one step ahead of them.

Test urine before prescribing antibiotics for most UTIs, says NICE.
Mayor S.
BMJ
2018;361:k2076.