Recurrent Urinary Tract Infection in the Gynecologic Practice: Time for Reviewing Concepts and Management Infecção do trato urinário recorrente na prática ginecológica: momento de rever conceitos e conduta

An independent panel of physicians with expert interest in urinary tract infection (UTI), including gynecologists, urologists, molecular biologists, infectologists, immunologists and epidemiologists met in a forum in Panama (Foro en Infeccciones Urinarias Recurrentes FIUR) to review diagnosis and treatment recommendations for the empiric therapy of uncomplicated UTIs taking into account antibiotic resistance and considering the use of guidelines to promote an optimal practice for recurrent urinary tract infections (RUTIs). Urinary tract infections are among the most common bacterial infections, and are a frequent complaint of women visiting their gynecologists. The accurate diagnosis and treatment of UTIs play an important role in cost-effective medical care and appropriate antimicrobial utilization.1 Antimicrobial resistance is a global issue, and concerns have been raised that some infections for which therapy is now available might become untreatable.2 The widespread empiric use of antibiotics, while convenient, potentially contributes to the development of antimicrobial resistance.2 The evolution of antimicrobial resistance in communityacquired Escherichia coli, however, requires a constant reevaluation of the empiric antimicrobial therapy.2 The variables to be considered in selecting an antimicrobial drug include efficacy, adverse effects, cost, and potential for future resistance.2 Practitioners always need to balance the antimicrobial selection for an optimal patient outcome with the potential for contributing to further antimicrobial resistance through widespread empiric use. Overly long or improper treatment regimens may also lead to drug resistance.