This ACE Clinical Guidance (ACG) highlights the importance of appropriate diagnosis and treatment of urinary tract infections (UTI) to reduce inappropriate antibiotic use. The ACG offers evidence-based recommendations on the treatment of UTI in adults, focusing on uncomplicated acute cystitis and pyelonephritis in healthy, non-pregnant pre-menopausal women. Principles of appropriate selection of antibiotics as well as patient education on antibiotic use and antimicrobial resistance awareness are also highlighted.
Dec 2023 update: practice tips in Table 4 for nitrofurantoin and fosfomycin for treatment of acute uncomplicated cystitis have been updated.
Download the PDF below to access the ACG.
Registered doctors, pharmacists and nurses may claim 1 Continuing Medical Education (CME)/Continuing Professional Education (CPE) point under category 3A/ category V-B for reading each ACG.
| ACG Recommendations |
|---|
| 1. | Avoid routinely screening for and treating asymptomatic bacteriuria. |
| 2. | Diagnose uncomplicated cystitis based on history and presentation in patients with two or more typical signs or symptoms such as dysuria, frequency, urgency, or absence of vaginal discharge. |
| 3. | a. Conduct a urine dipstick test to confirm diagnosis of uncomplicated cystitis where there is uncertainty; and
b. Conduct a urine culture and sensitivity test for unresolved or recurrent cystitis. |
| 4. | Suspect uncomplicated pyelonephritis in patients presenting with sudden-onset flank pain or tenderness, particularly when accompanied by other systemic symptoms such as fever, nausea or vomiting. |
| 5. | Conduct urine tests (dipstick or microscopy, plus culture and sensitivity) for all patients with suspected uncomplicated pyelonephritis to confirm diagnosis and guide management. |
| 6. | Prescribe nitrofurantoin empirically for uncomplicated cystitis; if nitrofurantoin is not suitable, prescribe amoxicillin-clavulanate or fosfomycin. |
| 7. | Prescribe amoxicillin-clavulanate empirically for patients with uncomplicated pyelonephritis and tailor antibiotic choice accordingly when urine culture and sensitivity results are available; if amoxicillin-clavulanate is not suitable, consider cefuroxime as an alternative.
|
Feedback
Click here to give us feedback on this ACG.