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Comparison of antibiotic treatment guidelines for urinary tract infections in 15 European countries: Results of an online survey
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (ReAct Europe)
Univ Geneva, Geneva Univ Hosp, Div Infect Dis & Infect Control Program, Geneva, Switzerland;Univ Geneva, Fac Med, Geneva, Switzerland;European Soc Clin Microbiol & Infect Dis ESCMID, ESCMID Study Grp Antimicrobial Stewardship ESGAP, Basel, Switzerland.ORCID iD: 0000-0002-1749-9464
Publ Hlth England, Primary Care Unit, Gloucester, England.
European Soc Clin Microbiol & Infect Dis ESCMID, ESCMID Study Grp Antimicrobial Stewardship ESGAP, Basel, Switzerland;Hosp Univ Virgen Macarena, Enfermedades Infecciosas Microbiol & Med Preventi, Seville, Spain;Univ Seville, Dept Med, Seville, Spain.
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2019 (English)In: International Journal of Antimicrobial Agents, ISSN 0924-8579, E-ISSN 1872-7913, Vol. 54, no 4, p. 478-486Article in journal (Refereed) Published
Abstract [en]

Appropriate antibiotic use for urinary tract infections (UTIs) is important in order to provide effective and safe treatment while minimising the risk of antimicrobial resistance development. This survey was carried out to compare existing national guidelines for UTIs in Europe. Experts in 37 European countries were asked to participate. An electronic questionnaire was used to obtain information on treatment recommendations, factors considered important when setting guidelines, acceptable resistance rates for empirical therapy, evidence grading, and existing resistance surveillance for uropathogens. Treatment guidelines and antimicrobial susceptibility data were collected. In total, 22 experts (59%) responded to the survey. National guidelines were missing in four countries and data were incomplete in three cases. Fifteen national guidelines published between 2004 and 2017 were included in the analysis. Great variability was found between guidelines in the selection of antibiotics, dosing regimens and treatment duration. For example, 10 different antibiotics were recommended as first-line therapy for uncomplicated cystitis. National surveillance data on antimicrobial susceptibility of uropathogens were available in 13 of 15 countries. Resistance epidemiology could not explain the observed differences between guidelines, and comparison of resistance rates was hampered by variations in methods. This study revealed major differences in treatment guidelines for UTIs within Europe, indicating that there are opportunities for improvement. More clinical research and a more systematic and stratified approach to resistance surveillance, including also antibiotics that are currently not available in all countries, is needed.

Place, publisher, year, edition, pages
2019. Vol. 54, no 4, p. 478-486
Keywords [en]
Urinary tract infection, Guidelines, Antimicrobial stewardship, AMS, Antimicrobial resistance surveillance, Antibiotic availability
National Category
Pharmacology and Toxicology
Identifiers
URN: urn:nbn:se:uu:diva-395789DOI: 10.1016/j.ijantimicag.2019.06.015ISI: 000487021400012PubMedID: 31229671OAI: oai:DiVA.org:uu-395789DiVA, id: diva2:1366175
Available from: 2019-10-28 Created: 2019-10-28 Last updated: 2019-10-28Bibliographically approved

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Malmros, KarinTängdén, Thomas

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