Objectives: Uncomplicated urinary tract infections (uUTIs) are a common problem in female patients. Management is mainly based on empirical prescribing, but there are concerns about overtreatment and antimicrobial resistance (AMR), especially in patients with recurrent uUTIs. Methods: A multidisciplinary panel of experts met to discuss diagnosis, treatment, prevention, guidelines, AMR, clinical trial design and the impact of COVID-19 on clinical practice. Results: Symptoms remain the cornerstone of uUTI diagnosis, and urine culture is necessary only when empirical treatment fails or rapid recurrence of symptoms or AMR is suspected. Specific antimicrobials are first-line therapy (typically nitrofurantoin, fosfomycin, trimethoprim/sulfamethoxazole and pivmecillinam, dependent on availability and local resistance data). Fluoroquinolones are not first-line options for uUTIs primarily due to safety concerns but also rising resistance rates. High-quality data to support most non-antimicrobial approaches are lacking. Local AMR data specific to community-acquired uUTIs are needed, but representative information is difficult to obtain; instead, identification of risk factors for AMR can provide a basis to guide empirical antimicrobial prescribing. The COVID-19 pandemic has impacted the management of uUTIs in some countries and may have long-lasting implications for future models of care. Conclusion: Management of uUTIs in female patients can be improved without increasing complexity, including simplified diagnosis and empirical antimicrobial prescribing based on patient characteristics, including a review of recent antimicrobial use and past pathogen resistance profiles, drug availability and guidelines. Current data for non-antimicrobial approaches are limited. The influence of COVID-19 on telehealth could provide an opportunity to enhance patient care in the long term.
Bibliographical noteFunding Information:
This work was supported by GlaxoSmithKline plc., who funded the consensus group meeting and editorial support but had no input into the content or writing of the manuscript. Editorial support in the preparation of this manuscript was provided by Michelle Preston and Karen Palmer (Livewire Editorial Communications), which was funded by GlaxoSmithKline plc.
None of the authors have received any financial compensation for writing this article. FW discloses research grants from Deutsches Zentrum fur Infecktionsforschung (DZIF) and consultancy fees from Achaogen, AstraZeneca, Bionorica, Janssen, MSD, OM Pharma/Vifor Pharma, Pfizer, Shionogi, VenatoRx, GSK, Klosterfrau GmbH and Eumedica; LN discloses consultancy fees from GSK, Utility Therapeutics, Iterum Therapeutics and Entos Pharmaceuticals; RB discloses consultancy fees from GSK and MV Medical Solutions; ACG discloses research grants from Eurofarma and consultancy fees from Cristalia, Entasis Therapeutics, Eurofarma, InfectoPharm, MSD, Pfizer and Zambon; LG discloses grants from the US National Institutes of Health, Agency for Healthcare Research and Quality and Veterans Affairs Health Services Research and Development, and an investigator-initiated grant from Rebiotix (a Ferring company); TH discloses consultancy fees from Danone and Utility Therapeutics, advisory board honoraria from GSK and Ocean Spray, and is a board member and equity owner of Fimbrion Therapeutics; GL discloses research grants from GSK, Inmunova and NIH, and consultancy fees from GSK; KN discloses consultancy fees from Adamed, bioMérieux, Bionorica, Eumedica, Hermes, Immunotek, Janssen, Klosterfrau, Medice and OM Pharma; AP discloses honoraria from Venus Remedies and bioMérieux; AS discloses consultancy fees from GSK; DAT discloses consultancy fees from GSK, Abbvie, Inc., Spero Therapeutics, Paratek Pharma and Integrated BioTherapeutics, Inc.; JTS discloses consultancy fees for Grunenthal, Bayer, OM Pharma, Asofarma and MSD; MHW discloses consultancy fees from AiCuris, Bayer, Crestone, Da Volterra, EnteroBiotix, The European Tissue Symposium, Ferring, GSK, Menarini, Merck, Nestle, Paratek, Pfizer, Phico Therapeutics, Qpex Biopharma, Seres, Surface Skins, Summit and Vaxxilon/Idorsia, lecture honoraria from Merck, Pfizer and Seres, and grants from Almirall, Da Volterra, EnteroBiotix, GSK, Merck, MicroPharm, Nabriva, Paratek, Pfizer, Seres, Summit and The European Tissue Symposium; SY discloses consultancy fees from GSK, lecture fees from MSD, and grants from Takeda, Ono and Nipponshinyaku; SSY discloses research funding from Sysmex. All other authors declare no competing interests.
© 2021 The Authors
- Acute cystitis
- Antimicrobial prescribing
- Antimicrobial resistance
- Recurrent urinary tract infection
- Uncomplicated urinary tract infection