Urological Infections

For the 2020 Urological Infections Guidelines, new and relevant evidence was identified, collated and appraised through a structured assessment of the literature. Broad and comprehensive literature searches, covering these sections were performed. Databases searched included Medline, EMBASE, and the Cochrane Libraries. The number of unique records identified, retrieved and screened for relevance for each section were:

  • 3.4 Uncomplicated cystitis: 694 abstracts; 78 full texts; all excluded.
  • 3.6 Uncomplicated pyelonephritis: 1,006 abstracts; 48 full texts; 13 included.
  • 3.7 Complicated urinary tract infections: 1,331 abstracts; 13 included
  • 3.10 Urethritis: 488 abstracts; 71 full texts; 30 included.

Specific changes include:

  • 3.4.4 Disease management of uncomplicated cystitis
    On March 11, 2019 the European Commission implemented stringent regulatory conditions regarding the use of fluoroquinolones due to their disabling and potentially long-lasting side effects. This legally binding decision is applicable in all EU countries. National authorities have been urged to enforce this ruling and to take all appropriate measures to promote the correct use of this class of antibiotics. In uncomplicated cystitis a fluoroquinolone should only be used when it is considered inappropriate to use other antibacterial agents that are commonly recommended for the treatment of these infections.
  • Table 4: Suggested regimens for empirical parenteral antimicrobial therapy in uncomplicated pyelonephritis has been updated to include last-line alternatives.
  • 3.10.6 Summary of evidence and recommendations for the diagnostic evaluation and antimicrobial treatment of urethritis have been updated to reflect the evidence.
  • Table 8: Suggested regimens for antimicrobial therapy for urethritis has been updated to reflect the evidence.