![]() ![]() Although this agent has been available for years, few clinical trials have evaluated its efficacy or in vitro activity against community Gram-negative uropathogens ( 5, 10- 12). Mecillinam is a novel oral beta-lactam antibiotic with considerable in vitro activity against the Enterobacteriaceae family ( 5, 9). However, reports of increasing resistance of Gram-negative bacteria to trimethoprim/sulfamethoxazole, trimethoprim and amoxicillin, as well as concern about the potential for increasing resistance to fluoroquinolones with increasing use, emphasize the need for alternative agents ( 2, 8). This is supported by a recent study by Talan et al ( 7), which showed that in patients with acute uncomplicated pyelonephritis, resistance to trimethoprim/sulfamethoxazole was associated with a significantly greater bacteriological and clinical failure rate. ![]() In areas where the prevalence of resistance to these agents is more than 10% to 20%, the guidelines recommend the use of a fluoroquinolone. Recent guidelines from the Infectious Disease Society of America ( 6) have recommended three days of treatment with trimethoprim/sulfamethoxazole or trimethoprim alone for the empirical therapy of acute uncomplicated cystitis. Although this approach to management is simple and relatively cost effective, it is dependent on having an antimicrobial agent that is safe and to which most causative organisms are susceptible. In typical cases, a urine culture is not necessary. ![]() Current management guidelines recommend empirical therapy for acute, uncomplicated lower UTIs in young women ( 2, 3). More than 90% of UTIs are due to enteric Gram-negative organisms, of which more than 80% are Escherichia coli ( 4, 5). Appropriate antimicrobial treatment for UTIs increases the probability of suppression and cure ( 2, 3). Fortunately, most episodes of uncomplicated UTIs do not result in long term sequelae. An estimated 10% to 20% of women will experience at least one infection during their lifetime ( 1). Acute urinary tract infections (UTIs) remain one of the most common problems for which patients seek medical treatment in the community. ![]()
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