Practical Guidelines on Antibiotic Treatment of Urinary Tract Infections

The aim of this chapter is to introduce the reader to the principles and limitations of guidelines and to give practical recommendations on antibiotic type, route of administration, dosing, and duration in the treatment of different severity types of urinary tract infections. An early step in clinical decision-making is to identify which antibiotics that are available for clinical use at a given site and time. We present a narrative review of guidelines recommendations developed by different international societies and institutions. Recommendations are presented according to clinical severity grade and risk factors. Unclear classification and inclusion criteria cause bias in treatment groups, and antibiotic resistance is a major confounder in studies on antibiotic treatment of UTI. Our analysis of the evidence base shows that most articles behind recommendations on first-line treatments are very old. This is a strong signal that we need new studies. In an era of antimicrobial stewardship, we advise running prospective registries, where clinical severity and risk factors could be better defined and inform prospective registry embedded RCTs.