Guideline: Management of Urinary Tract Infections in Pediatrics and Adults

Introduction: Urinary tract infections (UTIs) are among the most common infections worldwide, significantly impacting patient quality of life and imposing substantial clinical and economic burdens. Despite advancements in diagnosis and treatment, UTIs continue to cause high morbidity and mortality, ranging from simple cystitis to life-threatening sepsis. Addressing the discrepancy between evidence quality and recommendation strength in existing guidelines, the WikiGuidelines Group has developed a consensus statement. This guideline aims to provide evidence-based recommendations for the prevention, diagnosis, and management of UTIs across diverse clinical settings.

Key Recommendations:

1. Cranberry Products:
   • Recommendation: Cranberry juice or supplements are recommended for preventing symptomatic, culture-verified UTIs in women with recurrent UTIs, children, and individuals susceptible after interventions.
   • Quality of Evidence: Moderate
   • Recommendation Strength: Strong
2. Methenamine Hippurate:
   • Recommendation: Methenamine hippurate is recommended as an alternative to prophylactic antibiotics for preventing recurrent UTIs in patients with intact bladder anatomy.
   • Quality of Evidence: Moderate
   • Recommendation Strength: Strong
3. Topical Estrogen:
   • Recommendation: Vaginal estrogen therapy is recommended for postmenopausal women to reduce recurrent UTIs by restoring the vaginal microbiome.
   • Quality of Evidence: High
   • Recommendation Strength: Strong
4. Empirical Treatment Regimens:
   • Recommendation: For uncomplicated cystitis, nitrofurantoin is recommended as a first-line agent. For pyelonephritis, trimethoprim/sulfamethoxazole or a first-generation cephalosporin are reasonable first-line agents, depending on local resistance rates.
   • Quality of Evidence: Moderate
   • Recommendation Strength: Strong
5. Treatment Duration for Acute Cystitis in Adults:
   • Recommendation:
     • Nitrofurantoin: 5 days
     • Trimethoprim/sulfamethoxazole: 3 days
     • Oral fosfomycin: Single dose
   • Quality of Evidence: High
   • Recommendation Strength: Strong
6. Treatment Duration for Acute Pyelonephritis in Adults:
   • Recommendation:
     • Fluoroquinolones: 5–7 days
     • Dose-optimized β-lactams: 7 days
   • Quality of Evidence: High
   • Recommendation Strength: Strong
7. Antimicrobial Stewardship:
   • Recommendation: De-escalation of antibiotics and the use of mostly or all oral treatment regimens are recommended to optimize antimicrobial use and reduce adverse effects.
   • Quality of Evidence: High
   • Recommendation Strength: Strong

Conclusion: The consensus highlights a significant lack of high-quality prospective data in many areas related to UTIs, limiting the ability to provide clear recommendations. Implementing these evidence-based guidelines can enhance patient care by promoting effective prevention strategies, accurate diagnosis based on clinical symptoms, appropriate treatment durations, and robust antimicrobial stewardship. This approach is expected to improve clinical outcomes, reduce antimicrobial resistance, and preserve the effectiveness of current treatments.

Reference: Nelson Z, Aslan AT, Beahm NP, et al. Guidelines for the Prevention, Diagnosis, and Management of Urinary Tract Infections in Pediatrics and Adults: A WikiGuidelines Group Consensus Statement. JAMA Network Open. 2024;7(11). DOI: http://doi.org/10.1001/jamanetworkopen.2024.44495