@article{3144554,
    title = "Acute uncomplicated cystitis: from surveillance data to a rationale for
empirical treatment",
    author = "Katsarolis, Ioannis and Poulakou, Garyphallia and Athanasia, Sofia and and Kourea-Kremastinou, Jenny and Lambri, Niki and Karaiskos, Elias and and Panagopoulos, Periklis and Kontopidou, Flora V. and Voutsinas, Dionysios and and Koratzanis, Georgios and Kanellopoulou, Maria and Adamis, Georgios and and Vagiakou, Helen and Perdikaki, Pigi and Giamarellou, Helen and and Kanellakopoulou, Kyriaki and Collaborative Study Grp Antibiotic",
    journal = "International Journal of Antimicrobial Agents",
    year = "2010",
    volume = "35",
    number = "1",
    pages = "62-67",
    publisher = "Elsevier",
    issn = "0924-8579",
    doi = "10.1016/j.ijantimicag.2009.08.018",
    keywords = "Resistance; Co-trimoxazole; Fluoroquinolones; Mecillinam;
Nitrofurantoin; Cystitis; Escherichia coli",
    abstract = "The objectives of this study were to explore the epidemiological
features and resistance rates in uropathogens isolated from cases of
acute uncomplicated cystitis (AUC) in Greece, and subsequently to guide
empirical treatment. Urine samples from outpatients aged > 16 years were
cultured and for each uropathogen isolated non-susceptibility to orally
administered antimicrobial agents was defined. Demographic and clinical
data were provided in questionnaire form. From January 2005 to March
2006 a total of 1936 non-duplicate positive urinary cultures were
collected and 889 AUC cases were evaluated. Escherichia coli was the
main aetiological agent (83%). In the AUC group, non-susceptibility
rates for E. coli isolates were as follows: amoxicillin 25.8%;
co-trimoxazole 19.2%; cefalothin 14.9%; nitrofurantoin 10.7%;
amoxicillin/clavulanic acid 5.2%; nalidixic acid 6%; mecillinam 3.4%;
ciprofloxacin 2.2%; cefuroxime 1.7%, and fosfomycin 1.6%. Amoxicillin
and/or co-trimoxazole use in the previous 3 months was significantly
associated with isolation of a co-trimoxazole-resistant E. coli isolate.
The same applied for previous use of a fluoroquinolone agent and
isolation of a ciprofloxacin-resistant E. coli isolate. In conclusion,
increased co-trimoxazole non-susceptibility rates undermine its use as a
first-line agent in empirical treatment, especially in cases of recent
use of co-trimoxazole and/or amoxicillin. Fluoroquinolones display
potent in vitro activity against community uropathogens, but prudent use
is warranted for uncomplicated infections. Mecillinam and nitrofurantoin
could serve as effective front-line agents in an effort to design
fluoroquinolones-sparing regimens. (c) 2009 Elsevier B.V. and the
International Society of Chemotherapy. All rights reserved."
}