• American College of Obstetricians and Gynecologists (ACOG). Treatment of urinary tract infections in nonpregnant women. Washington (DC): American College of Obstetricians and Gynecologists (ACOG); 2008 Mar. 10 p. (ACOG practice bulletin; no. 91). [51 references]

This is the current release of the guideline.

The grades of evidence (I-III) and levels of recommendation (A-C) are defined at the end of the "Major Recommendations" field.

The following recommendations and conclusions are based on good and consistent scientific evidence (Level A):

• Screening for and treatment of asymptomatic bacteriuria is not recommended in nonpregnant, premenopausal women.
• Resistance rates higher than 15 to 20% necessitate a change in antibiotic class.
• In all cases of acute pyelonephritis, whether treatment is on an inpatient or outpatient basis, 14 days of total antimicrobial therapy should be completed.
• A 3-day antimicrobial regimen is the preferred treatment duration for uncomplicated acute bacterial cystitis in women, including women aged 65 years and older.

The following conclusion is based on limited or inconsistent evidence (Level B):

• The initial treatment of a symptomatic lower urinary tract infection (UTI) with pyuria or bacteriuria or both does not require a urine culture.

The following conclusions are based primarily on consensus and expert opinion (Level C):

• Beta-lactams, such as first-generation cephalosporins and amoxicillin, are less effective in the treatment of acute uncomplicated cystitis than those antimicrobials listed in the Table below.
• To diagnose bacteriuria, decreasing the colony count to 1,000 to 10,000 bacteria per milliliter in symptomatic patients will improve the sensitivity without significantly compromising specificity.

Table. Treatment Regimens for Uncomplicated Acute Bacterial Cystitis

Definitions:

Grades of Evidence

I Evidence obtained from at least one properly designed randomized controlled trial.

II-1 Evidence obtained from well-designed controlled trials without randomization.

II-2 Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.

II-3 Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments also could be regarded as this type of evidence.

III Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.

Levels of Recommendation

Level A — Recommendations are based on good and consistent scientific evidence.

Level B — Recommendations are based on limited or inconsistent scientific evidence.

Level C — Recommendations are based primarily on consensus and expert opinion.

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

• American College of Obstetricians and Gynecologists (ACOG). Treatment of urinary tract infections in nonpregnant women. Washington (DC): American College of Obstetricians and Gynecologists (ACOG); 2008 Mar. 10 p. (ACOG practice bulletin; no. 91). [51 references]

Not applicable: The guideline was not adapted from another source.

2008 Mar

American College of Obstetricians and Gynecologists - Medical Specialty Society

American College of Obstetricians and Gynecologists (ACOG)

American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins - Gynecology

Not stated

Not stated

This is the current release of the guideline.

Proposed performance measures are included in the original guideline document.

This NGC summary was completed by ECRI Institute on July 30, 2008. The information was verified by the guideline developer on August 20, 2008.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.