The full content of Annals is available to subscribers

Subscribe/Learn More  >
Reviews |

Increasing Antimicrobial Resistance and the Management of Uncomplicated Community-Acquired Urinary Tract Infections

Kalpana Gupta, MD, MPH; Thomas M. Hooton, MD; and Walter E. Stamm, MD
[+] Article, Author, and Disclosure Information

From University of Washington, Seattle, Washington

Disclaimer: Dr. Gupta has served as a consultant for and received research support and speaking honoraria from Procter & Gamble and Bayer Pharmaceutical. Dr. Hooton has received research support and speaking honoraria from Ortho-McNeil Pharmaceutical, Procter & Gamble, Bristol-Meyers Squibb, Pfizer, and Bayer Pharmaceutical. Dr. Stamm has served as a consultant for and received research support and honoraria from Procter & Gamble, Ortho-McNeil Pharmaceutical, and Bayer Pharmaceutical.

Acknowledgments: The authors thank Douglas Black, PharmD, and Melissa Dearey, PharmD candidate, for compiling the pharmacokinetic data.

Grant Support: In part by a grant from the National Institutes of Health (DK 53369).

Requests for Single Reprints: Walter E. Stamm, MD, Division of Allergy and Infectious Diseases, University of Washington School of Medicine, 1959 NE Pacific Street, BB1225, Box 356523, Seattle, WA 98195.

Current Author Addresses: Drs. Gupta, Hooton, and Stamm: Division of Allergy and Infectious Diseases, University of Washington School of Medicine, 1959 NE Pacific Street, BB1225, Box 356523, Seattle, WA 98195.

Ann Intern Med. 2001;135(1):41-50. doi:10.7326/0003-4819-135-1-200107030-00012
Text Size: A A A

Community-acquired urinary tract infections (UTIs) are among the most common bacterial infections in women. Therapy for these infections is usually begun before results of microbiological tests are known. Furthermore, in women with acute uncomplicated cystitis, empirical therapy without a pretherapy urine culture is often used. The rationale for this approach is based on the highly predictable spectrum of etiologic agents causing UTI and their antimicrobial resistance patterns. However, antimicrobial resistance among uropathogens causing community-acquired UTIs, both cystitis and pyelonephritis, is increasing. Most important has been the increasing resistance to trimethoprim–sulfamethoxazole (TMP–SMX), the current drug of choice for treatment of acute uncomplicated cystitis in women.

What implications do these trends have for treatment of community-acquired UTIs? Preliminary data suggest that clinical cure rates may be lower among women with uncomplicated cystitis treated with TMP–SMX when the infecting pathogen is resistant to TMP–SMX. Women with pyelonephritis also have less bacterial eradication and lower clinical cure rates when treated with TMP–SMX for an infection that is resistant to the drug. Therefore, in the outpatient setting, identifying risk factors for TMP–SMX resistance and knowing the prevalence of TMP–SMX resistance in the local community are important steps in choosing an appropriate therapeutic agent. When choosing a treatment regimen, physicians should consider such factors as in vitro susceptibility, adverse effects, cost-effectiveness, and selection of resistant strains. Using a management strategy that takes these variables into account is essential for maintaining the safety and efficacy of treatment for acute UTI.


Grahic Jump Location
Strategy for management of uncomplicated community-acquired urinary tract infections (UTI) in women.

TMP–SMX = trimethoprim–sulfamethoxazole.

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.