The best rules for antimicrobial stewardship in urogenital tract infections

Urinary tract infections (UTIs) belong to the most common community-acquired and nosocomial infections, but therapy of UTIs is limited by resistance of pathogens and nonoptimal using of antibacterials. Narrative review of recent (2020-2018) literature dedicated to antimicrobial stewardship (AMS) in urological infections has been done.

Analysis of recent 64 articles has shown following principles of AMS for UTIs: selecting the correct drug, correct dose, and shortest clinically effective duration of therapy whenever possible, is a base for optimal antimicrobial stewardship; symptomatic UTIs should be treated with antimicrobials to alleviate symptoms, and in the case of more serious infection, to prevent complications; in both symptomatic and asymptomatic infection, quantitative culture is the gold standard for diagnosis; we have to avoid prescriptions of antibiotics when possible; we have to follow European and National Guidelines; we must avoid prescription of fluoroquinolones as empiric therapy for UTIs by many reasons, one of these is urogenital tuberculosis; the choice of antibiotic for UTI should be based on local level of resistance of uropathogens.

Studies of antimicrobial stewardship in urology are limited. Nevertheless, there are some golden rules, which may help to reduce inappropriate use of antimicrobials, improve patient outcomes, reduce side effects of antibiotic therapy, decrease the emergence and spread of multidrug-resistant infections, as well as decrease total costs of the therapy.