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Joint report of SBI (Brazilian Society of Infectious Diseases), FEBRASGO (Brazilian Federation of Gynecology and Obstetrics Associations), SBU (Brazilian Society of Urology) and SBPC/ML (Brazilian Society of Clinical Pathology/Laboratory Medicine): recommendations for the clinical management of lower urinary tract infections in pregnant and non-pregnant women.
The Brazilian Journal of Infectious Diseases ( IF 3.4 ) Pub Date : 2020-04-30 , DOI: 10.1016/j.bjid.2020.04.002
Patricia de Rossi 1 , Sergio Cimerman 2 , José Carlos Truzzi 3 , Clóvis Arns da Cunha 4 , Rosiane Mattar 5 , Marinês Dalla Valle Martino 6 , Maurício Hachul 7 , Adagmar Andriolo 8 , José Ananias Vasconcelos Neto 9 , João Antônio Pereira-Correia 10 , Antonia M O Machado 11 , Ana Cristina Gales 12
Affiliation  

Urinary tract infection (UTI) is a common condition in women. There is an increased concern on reduction of bacterial susceptibility resulting from wrongly prescribing antimicrobials. This paper summarizes the recommendations of four Brazilian medical societies (SBI - Brazilian Society of Infectious Diseases, FEBRASGO - Brazilian Federation of Gynecology and Obstetrics Associations, SBU - Brazilian Society of Urology, and SBPC/ML - Brazilian Society of Clinical Pathology/Laboratory Medicine) on the management of urinary tract infection in women. Asymptomatic bacteriuria should be screened at least twice during pregnancy (early and in the 3rd trimester). All cases of significant bacteriuria (≥105CFU/mL in middle stream sample) should be treated with antimicrobials considering safety and susceptibility profile. In women with typical symptoms of cystitis, dipsticks are not necessary for diagnosis. Urine cultures should be collected in pregnant women, recurrent UTI, atypical cases, and if there is suspicion of pyelonephritis. First line antimicrobials for cystitis are fosfomycin trometamol in a single dose and nitrofurantoin, 100mg every 6hours for five days. Second line drugs are cefuroxime or amoxicillin-clavulanate for seven days. During pregnancy, amoxicillin and other cephalosporins may be used, but with a higher chance of therapeutic failure. In recurrent UTI, all episodes should be confirmed by urine culture. Treatment should be initiated only after urine sampling and with the same regimens indicated for isolated episodes. Prophylaxis options of recurrent UTI are behavioral measures, non-antimicrobial and antimicrobial prophylaxis. Vaginal estrogens may be recommended for postmenopausal women. Other non-antimicrobial prophylaxis, including cranberry and immunoprophylaxis, have weak evidence supporting their use. Antimicrobial prophylaxis may be offered as a continuous or postcoital scheme. In pregnant women, options are cephalexin, 250-500mg and nitrofurantoin, 100mg (contraindicated after 37 weeks of pregnancy). Nonpregnant women may use fosfomycin trometamol, 3g every 10 days, or nitrofurantoin, 100mg (continuous or postcoital).

中文翻译:

SBI(巴西传染病学会)、FEBRASGO(巴西妇产科协会联合会)、SBU(巴西泌尿外科学会)和 SBPC/ML(巴西临床病理学/实验室医学学会)联合报告:临床管理建议孕妇和非孕妇的下尿路感染。

尿路感染 (UTI) 是女性的常见疾病。人们越来越担心因错误开具抗菌药物而导致的细菌易感性降低。本文总结了四个巴西医学会的建议(SBI - 巴西传染病学会、FEBRASGO - 巴西妇产科协会联合会、SBU - 巴西泌尿外科学会和 SBPC/ML - 巴西临床病理学/实验室医学学会)关于女性尿路感染的管理。无症状菌尿应在怀孕期间(早孕期和孕晚期)至少筛查两次。考虑到安全性和敏感性,所有显着菌尿(中游样本中≥105CFU/mL)的病例均应使用抗菌药物进行治疗。对于有典型膀胱炎症状的女性,诊断时不需要试纸。孕妇、复发性尿路感染、非典型病例以及怀疑肾盂肾炎时应收集尿培养。膀胱炎的一线抗菌药物是单剂量磷霉素氨丁三醇和呋喃妥因,每 6 小时 100 毫克,持续 5 天。二线药物是头孢呋辛或阿莫西林克拉维酸 7 天。在怀孕期间,可以使用阿莫西林和其他头孢菌素,但治疗失败的可能性更高。在复发性尿路感染中,所有发作都应通过尿培养确认。治疗应仅在尿液取样后开始,并采用与孤立事件相同的治疗方案。复发性尿路感染的预防选择是行为测量、非抗菌和抗菌预防。可能建议绝经后妇女使用阴道雌激素。其他非抗菌预防,包括蔓越莓和免疫预防,支持其使用的证据不足。抗菌预防可以作为连续或性交后的方案提供。孕妇可选择头孢氨苄 250-500 毫克和呋喃妥因 100 毫克(怀孕 37 周后禁用)。非孕妇可使用磷霉素氨丁三醇,每 10 天 3g,或呋喃妥因,100mg(连续或性交后)。100mg(怀孕37周后禁用)。非孕妇可使用磷霉素氨丁三醇,每 10 天 3g,或呋喃妥因,100mg(连续或性交后)。100mg(怀孕37周后禁用)。非孕妇可使用磷霉素氨丁三醇,每 10 天 3g,或呋喃妥因,100mg(连续或性交后)。
更新日期:2020-04-30
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