The 2017 Update of the German Clinical Guideline on Epidemiology, Diagnostics, Therapy, Prevention, and Management of Uncomplicated Urinary Tract Infections in Adult Patients: Part 1

Abstract

Objectives: We aimed to update the 2010 evidence-and consensus-based national clinical guideline on the diagnosis and management of uncomplicated urinary tract infections (UTIs) in adult patients. Materials and Methods: An interdisciplinary group consisting of 17 representatives of 12 medical societies and a patient representative was formed. Systematic literature searches were conducted in MEDLINE, EMBASE, and the Cochrane Library to identify literature published in 2010-2015. Results: We provide 75 recommendations and 68 statements in the updated evidence-and consensus-based national clinical guideline. The diagnostics part covers practical recommendations on cystitis and pyelonephritis for each defined patient group. Clinical examinations, as well as laboratory testing and microbiological pathogen assessment, are addressed. Conclusion: In accordance with the global antibiotic stewardship initiative and considering new insights in scientific research, we updated our German clinical UTI guideline to promote a responsible antibiotic use and to give clear hands-on recommendations for the diagnosis and management of UTIs in adults in Germany for healthcare providers and patients.

Reliability of Symptom-Based Diagnosis of Uncomplicated Cystitis

“…Therefore, a peculiar symptomatology in concordance with a well-known microbial pattern of etiological agents, and the absence of complicating factors leading to a more severe outcome, advocates to base the diagnosis of AC on symptoms followed by empiric therapy, even self-initiated by the patient in particular cases [2,[5][6][7]. On the other hand, despite its cost-efficiency, the immediate empiric prescription of antibiotics in women with symptoms suggestive of AC may be problematic because the symptomatology of AC comprises a number of symptoms, which may also associate other pathologies [3,[8][9][10].…”

Xyloglucan + Gelose Combination versus Placebo as Adjuvant Therapy to First-Line Antimicrobials for Uncomplicated Urinary Tract Infection in Adults

“…In the interests of promoting responsible antibiotic use in accordance with the global antibiotic stewardship initiative, an interdisciplinary group of experts in Germany recently updated the national clinical guideline on management of uncomplicated UTIs in adults [21,22]. Using non-antibiotic alternatives such as xyloglucan + gelose to treat uncomplicated UTIs is another valuable strategy to provide effective symptomatic relief while preserving precious antibiotic resource for future generations.…”

The 2017 Update of the German Clinical Guideline on Epidemiology, Diagnostics, Therapy, Prevention, and Management of Uncomplicated Urinary Tract Infections in Adult Patients. Part II: Therapy and Prevention

“…5 Principally for gram-positive pathogens. 6 Only in extended-spectrum betalactamase resistance >10%. 7 Only high dosages investigated.…”

“…org/leitlinien/detail/ll/043-044.html) [6]. The category S3 refers to the German guideline classification form, where S3 represents the highest methodological standard and involves both evidence-and consensus-based concept to achieve guideline recommendations from an interdisciplinary panel group [5].…”

“…Part I focuses on the recommendations regarding the definition of patient groups and the diagnostics of uncomplicated bacterial UTI acquired in the outpatient setting in adult patients and was already published [6]. This publication of part II covers the treatment of acute episodes of cystitis and pyelonephritis as well as the prevention of recurrent UTIs (rUTI) in otherwise healthy women in the premenopause (standard group).…”