Community-acquired urinary tract infections are among the most common bacterial infections in women. Therapy for these infections is usually begun before results of microbiological tests are known. Furthermore, in women with acute uncomplicated cystitis, empirical therapy without a pretherapy urine culture is often used. The rationale for this approach is based on the highly predictable spectrum of etiologic agents causing UTI and their antimicrobial resistance patterns. However, antimicrobial resistance among uropathogens causing community-acquired UTIs, both cystitis and pyelonephritis, is increasing. Most important has been the increasing resistance to trimethoprim– sulfamethoxazole TMP–SMX, the current drug of choice for treatment of acute uncomplicated cystitis in women. What are the implications of these trends for treatment of community-acquired UTIs? Preliminary data indicate that clinical cure rates may be lower among women with uncomplicated cystitis treated with TMP–SMX when the infecting pathogen is resistant to TMP–SMX. Women with pyelonephritis also have less bacterial eradication and lower clinical cure rates when treated with TMP–SMX for an infection that is resistant to the drug. Thus, in the outpatient setting, identification of risk factors for TMP–SMX resistance and knowledge of the prevalence of TMP–SMX resistance in the local community become important steps in identifying an appropriate therapeutic agent. Physicians should consider such factors as in vitro susceptibility, adverse effects, cost-effectiveness, and selection of resistant strains when choosing a treatment regimen. The use of this type of management strategy will be critical to maintaining the safety and efficacy of treatment for acute UTI.
Mr. N. Prakash*1, Mr. E. Thirukumaran1, Mr. T. Murugan1, Mr. G. Sagunthan1, Mr. M. Praveen Kumar2, Mr. C. Jothimanivannan3 (Fri,) studied this question.