Evidence-Based Management of Urinary Tract Infections: Balancing Efficacy, Safety, and Antimicrobial Stewardship
Abstract
Urinary tract infections (UTIs) are some of the most prevalent infectious diseases around the globe, affecting about 150 million people every year and putting a considerable strain on healthcare systems, both financially and clinically. This comprehensive review takes a closer look at the current landscape of UTI treatment, shining a light on first-line antimicrobial agents like nitrofurantoin, trimethoprim-sulfamethoxazole, and fosfomycin, as well as alternative options such as fluoroquinolones, beta-lactams, aminoglycosides, and carbapenems. The review dives into how these treatments function, their effectiveness, and the emerging patterns of resistance, particularly the growing concern of antimicrobial resistance in common uropathogens, especially Escherichia coli. While there are established guidelines recommending specific first-line therapies, a noticeable gap remains between the evidence and what actually occurs in clinical practice, with fluoroquinolones like ciprofloxacin often being overprescribed for uncomplicated infections. The rising presence of multidrug-resistant organisms, such as extended-spectrum beta-lactamase-producing Enterobacterales, necessitates a careful reassessment of treatment strategies and a commitment to antimicrobial stewardship. With resistance rates exceeding 50% in certain regions for commonly used antibiotics, there's an urgent need for innovative treatment strategies, enhanced surveillance systems, and responsible antibiotic use to…
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