Open Access Highly Accessed Research article

Antibiotic treatment of acute uncomplicated cystitis based on rapid urine test and local epidemiology: lessons from a primary care series

Manuel Etienne12*, Emmanuel Lefebvre3, Noëlle Frebourg24, Hélène Hamel5, Martine Pestel-Caron24, François Caron12 and Bacyst Study Group

Author Affiliations

1 Infectious diseases, Rouen University Hospital, rue de Germont, Rouen F-76031, France

2 Research Group on Antimicrobials (GRAM-EA2656) IRIB, Rouen University Hospital, 22 boulevard Gambetta, Rouen 76000, France

3 Primary care department, Medical Faculty, 22 boulevard Gambetta, Rouen 76000, France

4 Bacteriology, Rouen University Hospital, rue de Germont, Rouen F-76031, France

5 Clinical research center, Rouen University Hospital, rue de Germont, Rouen F-76031, France

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BMC Infectious Diseases 2014, 14:137  doi:10.1186/1471-2334-14-137

Published: 11 March 2014

Abstract

Background

Acute uncomplicated cystitis (AUC) is an ideal target of optimization for antibiotic therapy in primary care. Because surveillance networks on urinary tract infections (UTI) mix complicated and uncomplicated UTI, reliable epidemiological data on AUC lack. Whether the antibiotic choice should be guided by a rapid urine test (RUT) for leukocytes and nitrites has not been extensively studied in daily practice. The aim of this primary care study was to investigate local epidemiology and RUT-daily use to determine the optimal strategy.

Methods

General practitioners included 18–65 years women with symptoms of AUC, performed a RUT and sent urines for analysis at a central laboratory. Different treatment strategies were simulated based on RUT and resistance results.

Results

Among 347 enrolled patients, 78% had a positive urine culture. Escherichia coli predominated (71%) with high rates of susceptibility to nitrofurantoin (100%), fosfomycin (99%), ofloxacin (97%), and even pivmecillinam (87%) and trimethoprim-sulfamethoxazole (87%). Modelization showed that the systematic use of RUT would reduce by 10% the number of patients treated. Fosfomycin for patients with positive RUT offered a 90% overall bacterial coverage, compared to 98% for nitrofurantoin. 95% for ofloxacin, 86% for trimethoprim-sulfamethoxazole and 78% for pivmecillinam.

Conclusion

Local epidemiology surveillance data not biased by complicated UTI demonstrates that the worldwide increase in antibiotic resistance has not affected AUC yet. Fosfomycin first line in all patients with positive RUT seems the best treatment strategy for AUC, combining good bacterial coverage with expected low toxicity and limited effect on fecal flora.

Trial registration

The current study was registered at clinicaltrials.gov (NCT00958295)

Keywords:
Acute uncomplicated cystitis; Urinary tract infection; Primary care; Rapid urine test; Antibiotic policy