Meher Rizvi - Associate Professor, Department of Microbiology and Immunology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman

Background and Aim : Urinary tract infections (UTIs) are among the most frequent infections inclinical practice requiring a considerable number of antibiotic prescriptions.Methods : The prescribing pattern in a healthcare facility can be understood by carrying out pointprevalence surveys or detailed audits. Questionnaires and surveys can also be utilized. It isimportant to appreciate that antimicrobial policies based on local antibiograms and education playan important role in nudging the clinician to prescribe antibiotics judiciously. Targetedantibiograms should be built for facilitating evidence based antimicrobial prescriptions.Results : It is important to bear in mind that management of cystitis and pyelonephritis, as well assimple and complicated UTI is markedly different. Nitrofurantoin, trimethoprim–sulfamethoxazole, fosfomycin, and pivmecillinam are useful first-line agents for cystitis. They areeffective against ESBL producers and thus are extremely useful empirical agents. Empirical useof fluoroquinolones, third generation cephalosporins, aminoglycosides, carbapenems should bereserved for pyelonephritis and other complications. In this age of mounting AMR it is useful toknow non-pharmacological prevention strategies for recurrent UTI with patients as it is becomingclear that community involvement is equally important in the combat against AMR. Adhesionblockers such as D-mannose, replacement topical estrogen therapy in postmenopausal women,probiotics, oral immunostimulants are being promoted for use in women to prevent cystitis.Conclusion : While it is important to refer and adhere to national guidelines, it is even better todevelop local antibiograms and guidelines in order to dispense optimum treatment and to halt theonward march of AMR.

Urinary tract infection, Antibiograms