Trattamento antibiotico empirico, mirato o ragionato? Dalla pratica clinica alle Linee Guida EAU 2017

Abstract

Empirical antibiotic treatment of urinary tract infections: from everyday clinical practice to EAU guidelines 2017Recent epidemiological data confirm the increasing problem of antimicrobial resistance not only for hospitalized, healthcare-associated patients but also for outpatients. In particular, the progressive increase in resistance to broad-spectrum antibiotics, such as third-generation cephalosporins, fluoroquinolones, or carbapenems in Enterobacteriaceae, is an alarming situation for all urologists and general practitioners. The management of uncomplicated urinary tract infections are an important step in antibiotic stewardship achievement: a new approach is urgently required. All international Guidelines on urological infections suggest to take into account the following parameters for choosing antimicrobial therapy: spectrum and susceptibility patterns of the aetiological pathogens; efficacy for the particular indication in clinical studies; tolerability and adverse reactions; adverse ecological effects; costs and availability. In other words, an accurate evaluation of all patients and bacteria-related factors should be performed, along with the consideration of local data of bacterial resistance rate. According to these principles and the available susceptibility patterns in Italy, fosfomycin trometamol 3 g single dose and nitrofurantoin, are considered as drugs of first choice.