El tratamiento de la cistitis aguda no complicada de la mujer en la comunidad ¿es un problema resuelto en el país?
Palabras clave:
cistitis, Escherichia coli, nitrofurantoína, combinación trimetoprim y sulfametoxazol, farmacorresistencia microbiana, infecciones urinarias
Resumen
Introducción: la práctica de la Medicina enfrenta frecuentemente al manejo de pacientes del sexo femenino con infección de vías urinarias no complicada, en las que se necesita iniciar un tratamiento empírico para Escherichia coli, basado en la identificación de los llamados antibióticos de primera línea para dicho germen y en el conocimiento de la resistencia local a los mismos.
Objetivos: analizar los textos de Medicina Interna, Nefrología, Microbiología, guías internacionales y otras publicaciones recientes para identificar los antibióticos como los de primera línea para el tratamiento de la cistitis aguda no complicada en la mujer: nitrofurantoína, fosfomicina, cotrimoxazol (trimetoprim-sulfametoxazol) y pivmecillinam. Resultados: de los antibióticos mencionados sólo están disponibles en el país la nitrofurantoína y el cotrimoxazol. En un estudio que hemos publicado recientemente se encontró que la resistencia de Escherichia coli a la nitrofurantoína fue 4% y al cotrimoxazol fue del 35%.
Conclusión: de los antibióticos considerados de primera línea para el tratamiento empírico de la cistitis aguda no complicada en la mujer, solo tenemos disponible en el país la nitrofurantoína y el cotrimoxazol, siendo baja (4%) la resistencia local de Escherichia coli a la nitrofurantoina y elevada (35%) al cotrimoxazol.
Citas
1. Hooton TM. Uncomplicated Urinary Tract Infection. N Engl J Med 2012; 366:1028-1037
2. Fihn SD. Clinical practice. Acute uncomplicated urinary tract infection in women. N Engl J Med. 2003;349(3):259-66.
3. Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, et al. Infectious Diseases Society of America; European Society for Microbiology and Infectious Diseases. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103-20. doi: 10.1093/cid/ciq257
4. Foxman B. Recurring urinary tract infection: incidence and risk factors. Am J Public Health. 1990;80(3):331-333.
5. Melgarejo L, Walder A, Ovando F, Velázquez G, Chírico C, Santa Cruz F. Rev Nefrol Dial Traspl. 2017; 37 (2): 96-103.
6. Nicolle, LE. Urinary Tract Infection and Pyelonephritis. En: Gilbert SJ, Weiner DE. National Kidney Foundation’s Primer on Kidney Diseases, 7th ed. Philadelphia: Elsevier; 2018. p. 427-434
7. Paterson DL. "Collateral damage" from cephalosporin or quinolone antibiotic therapy. Clin Infect Dis. 2004;38 Suppl 4:S341-5.
8. Grigoryan L, Zoorob R, Wang H, Trautner BW. Low Concordance With Guidelines for Treatment of Acute Cystitis in Primary Care. Open Forum Infect Dis. 2015;2(4):ofv159. doi: 10.1093/ofid/ofv159
9. Lindsay E. Nicolle LE, Norrby SR. Approach to the Patient with Urinary Tract Infection. En: Goldman L, Schafer AI, Goldman-Cecil Medicine, 2-Volume Set, (Cecil Textbook of Medicine) 25th ed. Philadelphia: Elsevier – Saunders; 2016. p.1872-1876
10. Gupta K, Trautner BW. Urinary Tract Infections, pyelonephritis, and Prostatitis. En: Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J. Harrison's Principles of Internal Medicine (Vol.1 & Vol.2) 19th ed. New York: McGraw-Hill Education; 2015. p. 861-868
11. Mensa Pueyo, J. Infecciones de las vías urinarias. En: Rozman Borstnar C, Cardellach F. Farreras-Rozman. Medicina Interna. 2 Vols. (Spanish Edition), 17th ed. Barcelona: Elsevier; 2016. p. 873-880
12. Hooton TM, Gupta K. Acute uncomplicated cystitis in women. UpToDate Inc. https://www.uptodate.com (Accessed on Jan 8, 2018)
13. Nicolle, LE. Urinary Tract Infection in Adults. En: Skorecki K, Chertow GM, Marsden PA, Taal MW, Yu ASL. Brenner and Rector's The Kidney, (2 Volume Set), 10th ed. Philadelphia: Elservier; 2016. p. 1231-1282
14. Hooton T. Bacterial Urinary Tract Infections. En: Johnson RJ, Feehally J, Floege J. En: Comprehensive Clinical Nephrology, 5th ed. Philadelphia: Elsevier – Saunders; 2015. p.632-643.
15. Pietrucha-Dilanchian P, Hooton TM. Diagnosis, Treatment, and Prevention of Urinary Tract Infection. En: Mulvey MA, Klumpp D, Stapleton A. Urinary Tract Infections: Molecular Pathogenesis and Clinical Management, 2nd Ed. Washington, DC, American Society for Microbiology Press; 2017. p. 41-68
16. Gupta K, Grigoryan L, Trautner B. Urinary Tract Infection. Ann Intern Med. 2017;167(7):ITC49-ITC64.
17. Velázquez G, Lird G, Melgarejo L, Walder A, Chírico C, Santa Cruz F. Resultados de urocultivos en adultos realizados por el laboratorio de microbiología del Hospital de Clínicas – San Lorenzo de enero del 2015 a agosto de 2016 y métodos de estudio de las infecciones urinarias disponibles en la institución. An. Fac. Cienc. Méd. 2017;50(2):51-65
18. Christiaens TC, De Meyere M, Verschraegen G, Peersman W, Heytens S, De Maeseneer JM. Randomised controlled trial of nitrofurantoin versus placebo in the treatment of uncomplicated urinary tract infection in adult women. Br J Gen Pract. 2002;52(482):729-34.
19. Bleidorn J, Gagyor I, Kochen MM, Wegscheider K, Hummers-Pradier E. Symptomatic treatment (ibuprofen) or antibiotics (ciprofloxacin) for uncomplicated urinary tract infection? results of a randomized, controlled pilot trial. BMC Med. 2010;8:30
20. Bleidorn J, Hummers-Pradier E, Schmiemann G, Wiese B, Gágyor I. Recurrent urinary tract infections and complications after symptomatic versus antibiotic treatment: follow-up of a randomised controlled trial. Ger Med Sci. 2016;14:Doc01.
21. Gágyor I, Hummers-Pradier E, Kochen MM, Schmiemann G, Wegscheider K, Bleidorn J. Immediate versus conditional treatment of uncomplicated urinary tract infection - a randomized-controlled comparative effectiveness study in general practices. BMC Infect Dis. 2012;12:146.
22. Warren JW, Abrutyn E, Hebel JR, Johnson JR, Schaeffer AJ, Stamm WE. Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Infectious Diseases Society of America (IDSA). Clin Infect Dis. 1999;29(4):745-58.
23. FDA Drug Safety Communication: FDA advises restricting fluoroquinolone antibiotic use for certain uncomplicated infections; warns about disabling side effects that can occur together. [Internet] [Updated 7-26-2016; cited 2018 Jan 8] Available from http://www.fda.gov/Drugs/DrugSafety/ucm500143.htm (Accessed on Jan 8, 2018).
24. McKinnell JA, Stollenwerk NS, Jung CW, Miller LG. Nitrofurantoin compares favorably to recommended agents as empirical treatment of uncomplicated urinary tract infections in a decision and cost analysis. Mayo Clin Proc. 2011;86(6):480-8
25. Ingalsbe ML, Wojciechowski AL, Smith KA, Mergenhagen KA. Effectiveness and safety of nitrofurantoin in outpatient male veterans. Ther Adv Urol 2015;7(4):186-193.
26. Kahlmeter G, Prevalence and antimicrobial susceptibility of pathogens in uncomplicated cystitis in Europe. The ECO.SENS study. Int J Antimicrob Agents. 2003;22 Suppl 2:49-52
27. Mavromanolakis E, Maraki S, Samonis G, Tselentis Y, and A. Cranidis. Effect of Norfloxacin, Trimethoprim-Sulfamethoxazole and Nitrofurantoin on Fecal Flora of Women with Recurrent Urinary Tract Infections. J. Chemother 1997;9:203-207.
28. Xu H, Gasparini A, Ishigami J, Mzayen K, Su G, Barany P, Ärnlöv J, Lindholm B, Elinder CG, Matsushita K, Carrero JJ. eGFR and the Risk of Community-Acquired Infections. Clin. J. Am. Soc. Nephrol. 2017;12:1399-1408
29. Sanchez G., Master R., Karlowsky J., Bordon J. In vitro antimicrobial resistance of urinary Escherichia coli isolates among U.S. outpatients from 2000 to 2010. Antimicrob Agents Chemother 2012;56:2181-2183.
30. Weber DJ. Collateral damage and what the future might hold. The need to balance prudent antibiotic utilization and stewardship with effective patient management. Int J Infect Dis 2006; 10(S2) S17–S24
31. Kahan NR, Kahan E, Waitman DA, Chinitz DP. Economic evaluation of an updated guideline for the empiric treatment of uncomplicated urinary tract infection in women. Isr Med Assoc J. 2004;6(10):588-91.
32. Kahan NR, Chinitz DP. Empiric treatment of uncomplicated UTI in women: wasting money when more is not better. J Clin Pharm Ther. 2004;29(5):437-41.
2. Fihn SD. Clinical practice. Acute uncomplicated urinary tract infection in women. N Engl J Med. 2003;349(3):259-66.
3. Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, et al. Infectious Diseases Society of America; European Society for Microbiology and Infectious Diseases. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103-20. doi: 10.1093/cid/ciq257
4. Foxman B. Recurring urinary tract infection: incidence and risk factors. Am J Public Health. 1990;80(3):331-333.
5. Melgarejo L, Walder A, Ovando F, Velázquez G, Chírico C, Santa Cruz F. Rev Nefrol Dial Traspl. 2017; 37 (2): 96-103.
6. Nicolle, LE. Urinary Tract Infection and Pyelonephritis. En: Gilbert SJ, Weiner DE. National Kidney Foundation’s Primer on Kidney Diseases, 7th ed. Philadelphia: Elsevier; 2018. p. 427-434
7. Paterson DL. "Collateral damage" from cephalosporin or quinolone antibiotic therapy. Clin Infect Dis. 2004;38 Suppl 4:S341-5.
8. Grigoryan L, Zoorob R, Wang H, Trautner BW. Low Concordance With Guidelines for Treatment of Acute Cystitis in Primary Care. Open Forum Infect Dis. 2015;2(4):ofv159. doi: 10.1093/ofid/ofv159
9. Lindsay E. Nicolle LE, Norrby SR. Approach to the Patient with Urinary Tract Infection. En: Goldman L, Schafer AI, Goldman-Cecil Medicine, 2-Volume Set, (Cecil Textbook of Medicine) 25th ed. Philadelphia: Elsevier – Saunders; 2016. p.1872-1876
10. Gupta K, Trautner BW. Urinary Tract Infections, pyelonephritis, and Prostatitis. En: Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J. Harrison's Principles of Internal Medicine (Vol.1 & Vol.2) 19th ed. New York: McGraw-Hill Education; 2015. p. 861-868
11. Mensa Pueyo, J. Infecciones de las vías urinarias. En: Rozman Borstnar C, Cardellach F. Farreras-Rozman. Medicina Interna. 2 Vols. (Spanish Edition), 17th ed. Barcelona: Elsevier; 2016. p. 873-880
12. Hooton TM, Gupta K. Acute uncomplicated cystitis in women. UpToDate Inc. https://www.uptodate.com (Accessed on Jan 8, 2018)
13. Nicolle, LE. Urinary Tract Infection in Adults. En: Skorecki K, Chertow GM, Marsden PA, Taal MW, Yu ASL. Brenner and Rector's The Kidney, (2 Volume Set), 10th ed. Philadelphia: Elservier; 2016. p. 1231-1282
14. Hooton T. Bacterial Urinary Tract Infections. En: Johnson RJ, Feehally J, Floege J. En: Comprehensive Clinical Nephrology, 5th ed. Philadelphia: Elsevier – Saunders; 2015. p.632-643.
15. Pietrucha-Dilanchian P, Hooton TM. Diagnosis, Treatment, and Prevention of Urinary Tract Infection. En: Mulvey MA, Klumpp D, Stapleton A. Urinary Tract Infections: Molecular Pathogenesis and Clinical Management, 2nd Ed. Washington, DC, American Society for Microbiology Press; 2017. p. 41-68
16. Gupta K, Grigoryan L, Trautner B. Urinary Tract Infection. Ann Intern Med. 2017;167(7):ITC49-ITC64.
17. Velázquez G, Lird G, Melgarejo L, Walder A, Chírico C, Santa Cruz F. Resultados de urocultivos en adultos realizados por el laboratorio de microbiología del Hospital de Clínicas – San Lorenzo de enero del 2015 a agosto de 2016 y métodos de estudio de las infecciones urinarias disponibles en la institución. An. Fac. Cienc. Méd. 2017;50(2):51-65
18. Christiaens TC, De Meyere M, Verschraegen G, Peersman W, Heytens S, De Maeseneer JM. Randomised controlled trial of nitrofurantoin versus placebo in the treatment of uncomplicated urinary tract infection in adult women. Br J Gen Pract. 2002;52(482):729-34.
19. Bleidorn J, Gagyor I, Kochen MM, Wegscheider K, Hummers-Pradier E. Symptomatic treatment (ibuprofen) or antibiotics (ciprofloxacin) for uncomplicated urinary tract infection? results of a randomized, controlled pilot trial. BMC Med. 2010;8:30
20. Bleidorn J, Hummers-Pradier E, Schmiemann G, Wiese B, Gágyor I. Recurrent urinary tract infections and complications after symptomatic versus antibiotic treatment: follow-up of a randomised controlled trial. Ger Med Sci. 2016;14:Doc01.
21. Gágyor I, Hummers-Pradier E, Kochen MM, Schmiemann G, Wegscheider K, Bleidorn J. Immediate versus conditional treatment of uncomplicated urinary tract infection - a randomized-controlled comparative effectiveness study in general practices. BMC Infect Dis. 2012;12:146.
22. Warren JW, Abrutyn E, Hebel JR, Johnson JR, Schaeffer AJ, Stamm WE. Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Infectious Diseases Society of America (IDSA). Clin Infect Dis. 1999;29(4):745-58.
23. FDA Drug Safety Communication: FDA advises restricting fluoroquinolone antibiotic use for certain uncomplicated infections; warns about disabling side effects that can occur together. [Internet] [Updated 7-26-2016; cited 2018 Jan 8] Available from http://www.fda.gov/Drugs/DrugSafety/ucm500143.htm (Accessed on Jan 8, 2018).
24. McKinnell JA, Stollenwerk NS, Jung CW, Miller LG. Nitrofurantoin compares favorably to recommended agents as empirical treatment of uncomplicated urinary tract infections in a decision and cost analysis. Mayo Clin Proc. 2011;86(6):480-8
25. Ingalsbe ML, Wojciechowski AL, Smith KA, Mergenhagen KA. Effectiveness and safety of nitrofurantoin in outpatient male veterans. Ther Adv Urol 2015;7(4):186-193.
26. Kahlmeter G, Prevalence and antimicrobial susceptibility of pathogens in uncomplicated cystitis in Europe. The ECO.SENS study. Int J Antimicrob Agents. 2003;22 Suppl 2:49-52
27. Mavromanolakis E, Maraki S, Samonis G, Tselentis Y, and A. Cranidis. Effect of Norfloxacin, Trimethoprim-Sulfamethoxazole and Nitrofurantoin on Fecal Flora of Women with Recurrent Urinary Tract Infections. J. Chemother 1997;9:203-207.
28. Xu H, Gasparini A, Ishigami J, Mzayen K, Su G, Barany P, Ärnlöv J, Lindholm B, Elinder CG, Matsushita K, Carrero JJ. eGFR and the Risk of Community-Acquired Infections. Clin. J. Am. Soc. Nephrol. 2017;12:1399-1408
29. Sanchez G., Master R., Karlowsky J., Bordon J. In vitro antimicrobial resistance of urinary Escherichia coli isolates among U.S. outpatients from 2000 to 2010. Antimicrob Agents Chemother 2012;56:2181-2183.
30. Weber DJ. Collateral damage and what the future might hold. The need to balance prudent antibiotic utilization and stewardship with effective patient management. Int J Infect Dis 2006; 10(S2) S17–S24
31. Kahan NR, Kahan E, Waitman DA, Chinitz DP. Economic evaluation of an updated guideline for the empiric treatment of uncomplicated urinary tract infection in women. Isr Med Assoc J. 2004;6(10):588-91.
32. Kahan NR, Chinitz DP. Empiric treatment of uncomplicated UTI in women: wasting money when more is not better. J Clin Pharm Ther. 2004;29(5):437-41.
