Amendments and updates to the ISKRACroatian national guidelines for the treatment and prophylaxis of urinary tract infections in adults

Kod odabira lijeka za infekcije mokraćnog sustava (IMS) gledamo njegov spektar djelovanja, in vitro djelotvornost, farmakokinetiku, farmakodinamiku, nuspojave, interakcije s drugim lijekovima, kontraindikacije za primjenu, mjesto liječenja, cijenu, jednostavnost primjene, individualne osobine pojedinačnog bolesnika i pojedinačne infekcije, poziciju na listi HZZO. Kod određivanja empirijske antimikrobne terapije za IMS moramo imati uvid u lokalna istraživanja uzročnika pojedinih kliničkih sindroma i njihovu osjetljivost na antimikrobna sredstva. Prema ISKRAhrvatskim nacionalnim smjernicama i nihovim dopunama i promjenama s obzirom na preporuke EUCAST-a za liječenje IMS, preporuča se sljedeće: – za akutne nekomplicirane IMS donjeg urotrakta žena kao prvi izbor nitrofurantoin u dozi 2×100 mg po. kroz 7 dana, ili fosfomicin 1×3,0 g po. jednokratno, kao alternativna terapija koamoksiklav 2×1,0 g po. kroz 7 dana, cefaleksin 2×1,0 g po. kroz 7 dana, cefuroksim aksetil, ili cefiksim, zatim norfloksacin 2×400 mg po. kroz 3 dana, – za akutni nekomplicirani pijelonefritis prvi izbor je koamoksiklav 2×1,0 g po. kroz 10–14 dana, a alternativna terapija su cefalosporini II ili III generacije kroz 10–14 dana, te ciprofloksacin 2×500 mg po. kroz 7–10 dana, – za komplicirane IMS žena lijek prvog izbora je koamoksiklav 2×1,0 g po. kroz 10–14 dana, a alternativna terapija je ceftibuten, odnosno ciprofloksacin 2×500 mg po. kroz 7–10 dana, – za akutne IMS mu{karaca koji imaju i sustavne simptome, lijek prvog izbora je ciprofloksacin 2×500 mg po. kroz 2 tjedna, a alternativna terapija je koamoksiklav 2×1,0 g po. kroz 14 dana, odnosno ceftibuten 14 dana, – za IMS muškaraca koji imaju tegobe koje odgovaraju bakterijskom prostatitisu lijek prvog izbora je ciprofloksacin 2×500 mg po. kroz 4 tjedna, a alternativna terapija su trimetoprim/sulfametoksazol ili ceftibuten, – za IMS trudnica, prema kliničkom sindromu, trajanju trudnoće i antibiogramu uzročnika, preporuča se terapija 7–14 dana: ceftibuten, koamoksiklav, nitrofurantoin, amoksicilin ili fosfomicin.When selecting appropriate antimicrobial treatment for urinary tract infections (UTIs), the following drug characteristics should be taken into account: spectrum of activity, in vitro efficacy, pharmacokinetics, pharmacodynamics, side effects, drug interactions, contraindications, the location of treatment, cost, ease of administration, individual characteristics of particular patient and infection, the position of the drug on the Croatian Health Insurance Fund medicine list. In determining the empirical antimicrobial therapy for UTIs, one has to consider the results of local research on causative pathogens for particular clinical syndromes and their susceptibility to antimicrobial agents. According to ISKRA Croatian National Guidelines and their amendments and updates, with regards to EUCAST recommendations for UTI treatmet, the following is recommended: – for acute uncomplicated lower UTIs in women, the drug of choice is nitrofurantoin (2×100 mg po. for 7 days), or fosfomycin (1×3.0 g po. once), and as alternative therapy co-amoxiclav (2×1.0 g po. for 7 days), cephalexin (2×1.0 g po. for 7 days), cefuroxime axetil or cefixime or, followed by norfloxacin (2×400 mg. po. for 3 days); – for acute uncomplicated pyelonephritis the drug of choice is coamoxiclav (2×1.0 g po. for 10–14 days), and as alternative therapy the 2nd or 3rd generation cephalosporins for 10–14 days, and ciprofloxacin (2×500 mg po. for 7–10 days), – for complicated UTIs in women the drug of choice is coamoxiclav (2×1.0 g po. for 10–14 days) and the alternative therapy is ceftibuten, that is ciprofloxacin (2×500 mg po. for 7–10 days); – for acute UTIs in men who have systemic symptoms, the drug of choice is ciprofloxacin (2×500 mg po. for 2 weeks), and alternative therapy is co-amoxiclav (2×1.0 g po. for 14 days) or ceftriaxone for 14 days; – for UTIs in men with complaints that correspond to chronic bacterial prostatitis the drug of choice is ciprofloxacin (2×500 mg po. for 4 weeks), and alternative therapies are trimethoprim / sulfamethoxazole or ceftibuten; – for UTIs in pregnant women, according to clinical syndromes, duration of pregnancy and antibiogram of the causative pathogen, the following 7–14 day therapy is recommended: ceftibuten, co-amoxiclav, nitrofurantoin, amoxicillin or fosfomycin