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El tratamiento antibiótico empírico de las infecciones del tracto urinario inferior debe basarse en los datos clínicos del paciente y en las tasas locales de sensibilidad antibiótica. El aumento de las resistencias de los uropatógenos ha obligado a modificar las recomendaciones para el tratamiento empírico de las infecciones urinarias. Actualmente se desaconseja el uso empírico de cotrimoxazol, ampicilina, cefalosporinas y quinolonas, ambas de primera generación. Las fluoroquinolonas han demostrado ser muy eficaces en estudios comparativos, pero el aumento de resistencias obliga a seleccionar el tipo de paciente que se puede beneficiar de estos antimicrobianos. Las cefalosporinas de segunda y tercera generación mantienen tasas de sensibilidad elevadas, aunque se deben tener en cuenta las mayores tasas de recurrencia asociadas a su utilización y la aparición de enterobacterias productoras de betalactamasas de espectro extendido en la comunidad. La amoxicilina-ácido clavulánico tiene menor eficacia erradicadora que las quinolonas. Fosfomicina-trometamol mantiene tasas de resistencia inferiores al 2% y ha demostrado su eficacia y seguridad con una dosis única. Nitrofurantoína también es activa en la actualidad, aunque precisa una administración de 7 días y no está exenta de toxicidad. Ambos agentes se recomiendan actualmente como opciones alternativas a las fluoroquinolonas en la infección no complicada del tracto urinario inferior.
Palabras clave:
Infección del tracto urinario inferior
Tratamiento antibiótico empírico
Resistencias
Empirical antibiotic treatment of lower urinary tract infections should be based on the patient's clinical data and on local sensitivity data. Because of the increase in resistance among uropathogens, recommendations on the empirical treatment of urinary tract infections have been modified. Currently, the empirical use of co-trimoxazole, ampicillin, and first-generation cephalosporins and quinolones is not recommended. Fluoroquinolones have been demonstrated to be highly effective in comparative studies but, because of the increase in resistance, the type of patient who can benefit from these antimicrobial agents must be selected. Second- and third-generation cephalosporins still have high sensitivity rates, although the higher recurrence rates associated with their use and the emergence of extended-spectrum beta-lactamaseproducing enterobacterial in the community should be taken into account. Amoxicillin-clavulanate is less effective in eradicating infections than quinolones. Fosfomycintrometamol has resistance rates of below 2% and single-dose therapy has been demonstrated to be safe and effective. Nitrofurantoin is also currently active, although it must be administered for 7 days and can produce toxicity. Both agents are currently recommended as alternative therapeutic options to fluoroquinolones in uncomplicated infections of the lower urinary tract.
Key words:
Lower urinary tract infection
Empirical antibiotic therapy
Resistance
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