Include Earlier Microbiological Results

Letters to the Editor The Diagnosis, Treatment, and Prevention of Recurrent Urinary Tract Infection by PD Dr. med. Guido Schmiemann; PD Dr. med. habil. Jennifer Kranz, FEBU, MHBA; Dr. med. Falitsa Mandraka, MME; Prof. Dr. med. Sören Schubert; Prof. Dr. med. Florian Wagenlehner; and Prof. Dr. med. Ildikó Gágyor in issue 11/2024

In all recurrent infections we should assume that a microbiological result from earlier episodes is available. After a recurrence, initial treatment can therefore be started on the basis of the latest available antibiogram and, if needed, modified at a later date.

Table 1 was taken from an earlier publication (1). What were the criteria for listing the antibiotics in Table 1 and categorizing them into first choice and second choice? They are neither sorted alphabetically nor by the number of resistant pathogens. The impression that is created is that in recurring urinary tract infections the overall best antibiotic of first choice is pivmecillinam. But if rates of resistant pathogens are considered, as is claimed in Table 1 of the article (2), then nitrofurantoin should be first on the list, followed by nitroxoline, Fosfomycin, pivmecillinam, and trimethoprim. Treatment with nitrofurantoin is more economical. In recurrences, a longer treatment duration is required.

Table 2 of the article lists effective substances for treating uncomplicated urinary tract infection. Does the dosage and duration of the treatment also apply for recurrent urinary tract infection or is the recommended duration of treatment longer in that scenario?

DOI: 10.3238/arztebl.m2024.0165

Prof. Dr. med. Pramod M. Shah
Frankfurt am Main

Conflict of interest statement

The author received a lecture honorarium and has been reimbursed for travel expenses by the Hessische Urologen eG cooperative.

References

1. Klingeberg A, Willrich N, Schneider M, et al.: The percentage of antibiotic resistance in uncomplicated community-acquired urinary tract infections—findings of the RedAres project. Dtsch Arztebl Int 2024; 121: 175–81.

2. Schmiemann G, Kranz J, Mandraka F, Schubert S, Wagenlehner F, Gágyor I: The diagnosis, treatment, and prevention of recurrent urinary tract infection. Dtsch Arztebl Int 2024; 121: 373–82.