Letters to the Editor
In Reply
We thank our correspondents for their lively interest in our CME article on recurrent urinary tract infections (1). Urinary tract infections undoubtedly are among the most common causes for prescribing antibiotics. Measures that support their rational use and critically considered use of antibiotics are therefore of great importance.
The most important issue is the correct diagnosis. In this regard we can only support the comments made by Laszig. The differential diagnosis of sexually transmitted infections as well as the identification of pathogens such as trichomonads and chlamydia requires particular attention and should always be considered when treating (recurrent) urinary tract infections. In the diagnostic algorithm of the guideline that is the basis for the article (2), the presence of newly occurring or changed vaginal discharge is listed as an indication of a genital infection.
Which causal role the intestinal microbiome has in recurrent urinary tract infections and especially which therapeutic options arise from this is not known to date. As far as we are aware no proof exists that damage to the individual microbiome caused by antibiotics is a causal factor in recurrent urinary tract infections, as was postulated by Otto and Barski. Similarly, high-quality evidence for the use of probiotics or other interventions affecting the microbiome that aim to reduce rates of recurrent urinary tract infections is lacking.
The recommendations for selecting antibiotics in our CME article are based on the current S3-guideline for uncomplicated urinary tract infections from the Association of the Scientific Medical Societies in Germany (AWMF) (2).
Regrettably, sorting in alphabetical order was implemented only in Tables 2 and 3. The sequence in Table 1 does not represent any rating/scoring, as Shah commented critically. Treatment duration and dose differ if antibiotic prevention is required in the individual case (Table 3 in [1]).
DOI: 10.3238/arztebl.m2024.0166
On behalf of the authors
PD Dr. med. Guido Schmiemann
Institut für Public Health und Pflegeforschung
Abteilung für Versorgungsforschung/Department for
Health Services Research
Universität Bremen
schmiemann@uni-bremen.de
Conflict of interest statement
GS receives payment for serving on the scientific advisory board of Deximed.
| 1. | 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. CrossRef VOLLTEXT |
| 2. | S3-Leitlinie Epidemiologie, Diagnostik, Therapie, Prävention und Management unkomplizierter, bakterieller, ambulant erworbener Harnwegsinfektionen bei erwachsenen Patienten. https://register.awmf.org/de/leitlinien/detail/043–044 (last accessed 23. September 2024.) |
