Uncomplicated Urinary Tract Infection: Should an Antibiotic be Prescribed, and if so Which One?german translation / full article
A 25 year old woman presents with burning pain on micturition, pollakisuria, and crampy lower abdominal discomfort in primary care. After exclusion of red flags, uncomplicated urinary tract infection can be assumed. Guidelines regarding the treatment in this situation are contradictory. Should an antibiotic be prescribed, and if so which one?
Immediate antibiotic therapy is the internationally accepted state of the art in the treatment of uncomplicated urinary tract infections, because a reduction of symptoms and disease duration has been proven in randomised controlled trials. First line agents in Germany are Nitrofurantoin (2 x 100 mg for 3–5 days) and Fosfomycin (3000 mg single dose). Existing contraindications have to be taken into account (GFR 80 ml/min for fosfomycin). Due to the high spontaneous resolution also a delayed antibiotic treatment seems to be justified in patients who wish to wait and use it when symptoms do not resolve.