scholarly journals Uropathogen Antibiotic Resistance in Adult Women Presenting to Family Physicians with Acute Uncomplicated Cystitis

2004 ◽  
Vol 15 (5) ◽  
pp. 266-270 ◽  
Author(s):  
Warren J McIsaac ◽  
Tony Mazzulli ◽  
Rahim Moineddin ◽  
Janet Raboud ◽  
Susan Ross
Keyword(s):  
Antibiotic Resistance ◽  
Family Physicians ◽  
Empirical Treatment ◽  
Western Canada ◽  
Adult Women ◽  
Eastern Canada ◽  
Acute Cystitis ◽  
Exact Test ◽  
Acute Uncomplicated Cystitis ◽  
Uncomplicated Cystitis

BACKGROUND: Increasing rates of trimethoprim-sulfamethoxazole (TMP-SMX) resistance among uropathogens have raised concerns about its continued role in empirical treatment of acute uncomplicated cystitis in adult women.OBJECTIVES: To determine current rates of antibiotic resistance among uropathogens in the community.METHOD: Urine culture reports from adult women with symptoms of cystitis attending the offices of family physicians from across Canada were examined. Antibiotic sensitivities and the total number of antibiotics an organism was resistant to was determined.RESULTS: In 446 women, 235 (61.4%) positive urine cultures were identified. Of these, 38.2% were resistant to at least one antibiotic and 21.5% were resistant to two or more antibiotics. The rate of ampicillin resistance was 34.1%. For TMP-SMX, resistance was reported in 10.8% of samples. Antibiotic resistance was higher in British Columbia (55%) and western provinces (48%), compared with Ontario (33.3%) and the eastern provinces (26.3%, P=0.04, Fisher's exact test). Multidrug resistance was also higher in western Canada (33.9%) than in eastern Canada (16.6%, P=0.007).CONCLUSIONS: TMP-SMX resistance in Canada remains within current recommended guidelines, allowing for its continued use as a first line empirical treatment for acute cystitis in adult women. The reasons for higher rates of antibiotic resistance in western Canada merit further study.

scholarly journals The Management of Acute Uncomplicated Cystitis in Adult Women by Family Physicians in Canada

2008 ◽  
Vol 19 (4) ◽  
pp. 287-293 ◽  
Author(s):  
Warren J McIsaac ◽  
Preeti Prakash ◽  
Susan Ross
Keyword(s):  
Primary Care Physicians ◽  
Urine Culture ◽  
Family Physicians ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Adult Women ◽  
First Line ◽  
Acute Cystitis ◽  
Acute Uncomplicated Cystitis ◽  
Uncomplicated Cystitis

INTRODUCTION: There are few Canadian studies that have assessed prescribing patterns and antibiotic preferences of physicians for acute uncomplicated cystitis. A cross-Canada study of adult women with symptoms of acute cystitis seen by primary care physicians was conducted to determine current management practices and first-line antibiotic choices.METHODS: A random sample of 2000 members of The College of Family Physicians of Canada were contacted in April 2002, and were asked to assess two women presenting with new urinary tract symptoms. Physicians completed a standardized checklist of symptoms and signs, indicated their diagnosis and antibiotics prescribed. A urine sample for culture was obtained.RESULTS: Of the 418 responding physicians, 246 (58.6%) completed the study and assessed 446 women between April 2002 and March 2003. Most women (412 of 420, for whom clinical information about antibiotic prescriptions was available) reported either frequency, urgency or painful urination. Physicians would have usually ordered a urine culture for 77.0% of the women (95% CI 72.7 to 80.8) and prescribed an antibiotic for 86.9% of the women (95% CI 83.3 to 90.0). The urine culture was negative for 32.8% of these prescriptions. The most commonly prescribed antibiotic was trimethoprim/sulfamethoxazole (40.8%; 95% CI 35.7 to 46.1), followed by fluoroquinolones (27.4%; 95% CI 22.9 to 32.3) and nitrofurantoin (26.6%; 95% CI 22.1 to 31.4).CONCLUSION: Empirical antibiotic prescribing is standard practice in the community, but is associated with high levels of unnecessary antibiotic use. While trimethoprim/sulfamethoxazole is the first-line empirical antibiotic choice, fluoroquinolone antibiotics have become the second most commonly prescribed empirical antibiotic for acute cystitis. The effect of current prescribing patterns on community levels of quinolone-resistantEscherichia colimay need to be monitored.

scholarly journals Fosfomycin: A First-Line Oral Therapy for Acute Uncomplicated Cystitis

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
George G. Zhanel ◽  
Andrew J. Walkty ◽  
James A. Karlowsky
Keyword(s):  
Clinical Trials ◽  
Safety Profile ◽  
Cross Resistance ◽  
Adult Women ◽  
First Line ◽  
Favorable Safety Profile ◽  
E Coli ◽  
Acute Uncomplicated Cystitis ◽  
Uncomplicated Cystitis ◽  
Favorable Safety

Fosfomycin is a new agent to Canada approved for the treatment of acute uncomplicated cystitis (AUC) in adult women infected with susceptible isolates ofE. coliandEnterococcus faecalis. We reviewed the literature regarding the use of oral fosfomycin for the treatment of AUC. All English-language references from 1975 to October 2015 were reviewed. In Canada, fosfomycin tromethamine is manufactured as Monurol® and is available as a 3-gram single dose sachet. Fosfomycin has a unique chemical structure, inhibiting peptidoglycan synthesis at an earlier site compared toβ-lactams with no cross-resistance with other agents. Fosfomycin displays broad-spectrum activity against ESBL-producing, AmpC-producing, carbapenem-non-susceptible, and multidrug-resistant (MDR)E. coli. Resistance to fosfomycin inE. coliis rare (<1%). Fosfomycin is excreted unchanged in the urine by glomerular filtration with peak urinary concentration ~4000 µg/mL and remains at concentrations >100 µg/mL for 48 hours after a single 3-gram oral dose. No dosage adjustments are required in elderly patients, in pregnant patients, or in either renal or hepatic impairment. Fosfomycin demonstrates a favorable safety profile, and clinical trials have demonstrated efficacy in AUC that is comparable to ciprofloxacin, nitrofurantoin, and trimethoprim-sulfamethoxazole. Fosfomycin’s in vitro activity against common uropathogens, including MDR isolates, its favorable safety profile including pregnancy patients, drug interactions, and clinical trials data demonstrating efficacy in AUC, has resulted in Canadian, US, and European guidelines/authorities recommending fosfomycin as a first line agent for the treatment of AUC.

scholarly journals Greek Version of the Acute Cystitis Symptom Score. Part I: Linguistic Validation

2020 ◽  
Author(s):  
Konstantinos Stamatiou ◽  
Evangelia Samara ◽  
Jakhongir F. Alidjanov ◽  
Kurt G. Naber ◽  
Adrian Pilatz ◽  
...  
Keyword(s):  
Symptom Score ◽  
Healthcare Professionals ◽  
American English ◽  
Greek Version ◽  
Linguistic Validation ◽  
Acute Cystitis ◽  
Original Language ◽  
Acute Uncomplicated Cystitis ◽  
Uncomplicated Cystitis ◽  
Self Reporting Questionnaire

Objective: The Acute Cystitis Symptom Score (ACSS) was developed and validated as a self-reporting questionnaire for diagnosing and monitoring acute, uncomplicated cystitis (AC) in female patients. The study aims at the translation of the ACSS into Greek from original Russian as a source and American English as a new master version and at its linguistic validation. Material and Methods: Three independent professional native Greek translators, two of them experts in Russian and one in English, translated the ACSS from Russian and American English into Greek. The second group of three translators translated each of the three versions back into the original language to detect or correct any important discrepancies. These three Greek versions were then used for linguistic validation. Results: The English to Greek translation reflected more the spoken language, the two Russian to Greek translations more the written, formal language. A total of 60 randomly selected females and 30 healthcare professionals was asked about their preferences and to comment on each of the three translations. Considering all comments the scientific committee (SC) developed the Greek consensus version. For cognitive assessment additional 30 healthcare professionals and 30 females were asked to comment on the intelligibility of all items. Considering their comments the linguistically validated Greek study version was established by the SC. Conclusion: The linguistically validated Greek version of the ACSS can now be used for the clinical validation study.

scholarly journals Validation of the American English Acute Cystitis Symptom Score

Antibiotics ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. 929
Author(s):  
Jakhongir F. Alidjanov ◽  
Kurt G. Naber ◽  
Adrian Pilatz ◽  
Florian M. Wagenlehner
Keyword(s):  
Symptom Score ◽  
Clinical Success ◽  
American English ◽  
Clinical Success Rate ◽  
Acute Cystitis ◽  
Sum Score ◽  
Patient Reported ◽  
Acute Uncomplicated Cystitis ◽  
Uncomplicated Cystitis ◽  
Self Reporting Questionnaire

The diagnosis of acute uncomplicated cystitis (UC) is usually based on clinical symptoms. The study aims to develop and validate the American-English Acute Cystitis Symptom Score (ACSS), a self-reporting questionnaire for diagnosis and patient-reported outcome in women with acute uncomplicated cystitis (UC). After certified translation into American-English and cognitive assessment, the clinical validation of the ACSS was performed embedded in a US phase-II trial. 167 female patients with typical symptoms of UC were included in the study following US Food and Drug Administration (FDA) guidance. At Day 1 (diagnosis), the mean (SD) sum score of the six ACSS typical symptoms reached 10.60 (2.51). Of 100 patients followed-up last time on Day 5 or 6 (End-of-treatment, EoT), 91 patients showed clinical success according to the favored ACSS criteria (sum score of typical symptoms 0.98 (1.94)). There was no correlation between the severity of symptoms on Day 1 or between clinical success rate at EoT and level of bacteriuria on Day 1. The American-English ACSS showed high predictive ability and responsiveness and excellent levels of reliability and validity. It can now be recommended as the new master version in clinical and epidemiological studies, in clinical practice, or for self-diagnosis of women with symptoms of UC.

Acute uncomplicated cystitis: from surveillance data to a rationale for empirical treatment

2010 ◽  
Vol 35 (1) ◽  
pp. 62-67 ◽  
Author(s):  
Ioannis Katsarolis ◽  
Garyphallia Poulakou ◽  
Sofia Athanasia ◽  
Jenny Kourea-Kremastinou ◽  
Niki Lambri ◽  
...  
Keyword(s):  
Empirical Treatment ◽  
Surveillance Data ◽  
Acute Uncomplicated Cystitis ◽  
Uncomplicated Cystitis

scholarly journals Additional assessment of Acute Cystitis Symptom Score questionnaire for patient-reported outcome measure in female patients with acute uncomplicated cystitis: part II

2019 ◽  
Vol 38 (8) ◽  
pp. 1977-1988 ◽  
Author(s):  
J. F. Alidjanov ◽  
K. G. Naber ◽  
A. Pilatz ◽  
A. Radzhabov ◽  
M. Zamuddinov ◽  
...  
Keyword(s):  
Clinical Cure ◽  
Missing Values ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Summary Score ◽  
Acute Cystitis ◽  
Female Patients ◽  
Patient Reported ◽  
Acute Uncomplicated Cystitis ◽  
Uncomplicated Cystitis

Abstract Purpose Since symptomatic, non-antibiotic therapy has become an alternative approach to treat acute cystitis (AC) in women, suitable patient-reported outcome measures (PROM) are urgently needed. The aim of this part II of a larger non-interventional, case–control study was the additional assessment of the ACSS as a suitable PROM. Methods Data from 134 female patients with diagnosed acute uncomplicated cystitis were included in the current analysis with (1) a summary score of “Typical” domain of 6 and more; (2) at least one follow-up evaluation after the baseline visit; (3) no missing values in the ACSS questionnaire data. Six different predefined thresholds based on the scoring of the ACSS items were evaluated to define “clinical cure”, also considering the draft FDA and EMA guidelines. Results Of the six different thresholds tested, a summary score of the five typical symptoms of 5 and lower with no symptom more than 1 (mild), without visible blood in urine, with or without including QoL issues was favoured, which partially also could be adapted to the draft FDA and EMA guidelines. The overall patient’s clinical assessment (“Dynamic” domain) alone was not sensitive enough for a suitable PROM. Conclusions Scoring of the severity of symptoms is needed not only for diagnosis, but also for PROM to define “clinical cure” of any intervention, which could be combined with QoL issues. Results of the study demonstrated that the ACSS questionnaire has the potential to be used as a suitable PROM and should further be tested in prospective clinical studies.

scholarly journals General principles of uncomplicated cystitis therapy during pregnancy

2021 ◽  
pp. 121-126
Author(s):  
V. L. Tyutyunnik ◽  
N. E. Kan ◽  
L. V. Khachatryan
Keyword(s):  
Pregnant Women ◽  
Clinical Symptoms ◽  
Acute Cystitis ◽  
Microbiological Test ◽  
Fosfomycin Trometamol ◽  
Acute Uncomplicated Cystitis ◽  
Tract Infections ◽  
Uncomplicated Cystitis ◽  
Total Elimination

Urinary tract infections during pregnancy are associated with severe complications. Earlier initiation of antibiotic treatment for acute uncomplicated cystitis, reduces the various complications.Objective. To assess the effectiveness of fosfomycin in the treatment of acute uncomplicated cystitis during II and III trimester of pregnancy.Material and methods. The study included 74 pregnant women who had acute uncomplicated cystitis in II or III trimesters. All patients received fosfomycin trometamol 3.754 g (equivalent to 3 g fosfomycin) as antimicrobial therapy for acute uncomplicated cystitis. The drug was prescribed to 24 pregnant women in the II, and 50 in the III trimester of pregnancy.Results. After treatment with fosfomycin signs of acute cystitis gone in all patients. At the same time, regression of clinical symptoms was noted during the next days after therapy in 95.9% (n = 71) of cases. Repeated microbiological test of the middle portion of urine was performed 7 days after the end of antibiotic therapy. In 94.6% (n = 70) cases, total elimination of the pathogen was achieved. In 5.4% (n = 4) cases, there was a significant decrease of colonization Follow-up for three months showed the absence of recurrence of acute cystitis in all pregnant women who were included in the study.Conclusion. Fosfomycin is a highly effective drug in the treatment of uncomplicated cystitis during pregnancy.

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