Summary of guidelines from the Polish Urological Association, Polish Society of Gynaecologists and Obstetricians, and Polish Society of Family Medicine on the diagnosis, therapy, and management of community-acquired lower urinary tract infections.

Abstract

Introduction: This publication provides a summary of national guidelines developed in response to the regional characteristics of aetiological factors, resistance patterns, and the availability of antibacterial drugs in Poland.

Material and methods: After reviewing the epidemiological evidence, case-control studies, randomised control trials, and current international guidelines and statements, a Polish multidisciplinary group prepared the final recommendations. These recommendations cover diagnosis and management of community-acquired lower urinary tract infections in both genders, pregnant and breastfeeding women, recurrent lower urinary tract infections, and asymptomatic bacteriuria.

Results: The regional choice of antimicrobial agents for first-line therapy of uncomplicated cystitis in women includes fosfomycin trometamol, pivmecillinam, furazidin (furagin), and nitroxoline. For men, co-trimoxazole or fluoroquinolone therapy is recommended. Pivmecillinam and fosfomycin are recommended for the treatment of pregnant and breastfeeding women. For continuous prophylaxis of recurrent urinary tract infections in women, the following antimicrobial agents can be used: fosfomycin trometamol, trimethoprim, furazidin (furagin), and cefaclor. The significance of behavioural management and the use of vaginal hormonal therapy, vaginal probiotics, and immunoprophylaxis is emphasised. Asymptomatic bacteriuria should be treated in pregnant women and in patients prior to surgical intervention in the urinary tract.

Conclusions: New national guidelines based on locally available therapeutic resources should contribute to a more rational choice of therapy in patients with lower urinary tract infection and asymptomatic bacteriuria in Poland.