Management of uncomplicated urinary tract infections

Trimethoprim-sulfamethoxazole or trimethoprim should be used as first-line therapy because of its low cost and efficacy for uncomplicated urinary tract infections in women unless the prevalence of resistance to these agents among uropathogens in the community is greater than 10% to 20%. The fluoroquinolones are more expensive, broader in spectrum, and therefore, should be reserved for communities with rates of resistance to trimethoprim of greater than 10% to 20% or in patients who either cannot tolerate trimethoprim-sulfamethoxazole or have recurrent urinary tract infections. Other options include a 7-day course of nitrofurantoin or a single dose of fosfomycin. The use of first-generation cephalosporins or aminopenicillins is generally not recommended because of high levels of resistance and recurrence. Although resistance to the third-generation cephalosporins is lower than to the first generation, these agents are considered third-line agents because of their cost and efficacy. In an excellent review article, Gupta and others outlined the treatment of uncomplicated urinary tract infections in women (see Figure).