ArticleAntimicrobial resistance and infection control2023
Antibiotic treatment failure of uncomplicated urinary tract infections in primary care.
Article in Antimicrobial resistance and infection control, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 17 citations in OpenAlex.
- Definitions and rates of treatment failure in females with uncomplicated urinary tract infection: a systematic literature review.The Journal of antimicrobial chemotherapy · 2026Pooled it
- When Empiric Therapy Fails: Clinical and Economic Consequences in uUTIs Among US Women.Microorganisms · 2026Article
- The evidence landscape for direct-from-urine antibiotic susceptibility testing (AST) for urinary tract infection (UTI): a scoping review.JAC-antimicrobial resistance · 2026Review
- Mapping antibiotic treatment failure definitions and criteria in ambulatory care: a systematic literature review.JAC-antimicrobial resistance · 2026Review
- Review
- Deep Learning-Based Rapid Identification ofRisk management and healthcare policy · 2026Article
- CAUTIon - not all UTIs are the same.Nature reviews. Urology · 2025Review
- Co-resistance between oral antibiotics for pyelonephritis and those for cystitis-applying an escalation antibiogram model to local community data.JAC-antimicrobial resistance · 2025Article
- Antimicrobial Prophylaxis for Recurrent Urinary Tract Infections in Premenopausal and Postmenopausal Women: A Retrospective Observational Study from an Outpatient Clinic in a Tertiary University Hospital.Antibiotics (Basel, Switzerland) · 2025Article
- Factors affecting antibiotic appropriateness in uncomplicated urinary tract infections in primary care.Scientific reports · 2025Observational
- Travel to low- and middle-income countries and travellers' diarrhoea increase risk of mismatching antimicrobial therapy for urinary tract infection.Journal of travel medicine · 2025Article
- Urinary tract infections: pathogenesis, host susceptibility and emerging therapeutics.Nature reviews. Microbiology · 2025Review
- Urinary tract infections in women in Catalonia, Spain: a population-based observational cohort study in primary care.Frontiers in pharmacology · 2025Article
- Antimicrobial Management of Urinary Tract Infections: Insights from a Tertiary Care Hospital in Oman.Oman medical journal · 2025Article
- Urinary tract infections: a retrospective cohort study of (mis)matching antimicrobial therapy and clinical outcome among Finnish adults.JAC-antimicrobial resistance · 2024Article
- Nanohybrid Composites Based on TiOMolecules (Basel, Switzerland) · 2023Article
- Understanding patient and healthcare provider perspectives of uncomplicated urinary tract infection: patient journey, disease management, and the impact of antimicrobial resistance.Therapeutic advances in infectious diseaseArticle
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Authors and funding
11 authors at 6 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundHigher resistance rates of > 20% have been noted in Enterobacteriaceae urinary isolates towards ciprofloxacin and co-trimoxazole (C + C) in Singapore, compared with amoxicillin-clavulanate and nitrofurantoin (AC + N). This study examined if treatment failure varied between different antibiotics, given different resistant rates, for uncomplicated urinary tract infections (UTIs) managed in primary care. We also aimed to identify gaps for improvement in diagnosis, investigations, and management.
methodsA retrospective cohort study was conducted from 2019 to 2021 on female patients aged 18-50 with uncomplicated UTIs at 6 primary care clinics in Singapore. ORENUC classification was used to exclude complicated UTIs. Patients with uncomplicated UTIs empirically treated with amoxicillin-clavulanate, nitrofurantoin, ciprofloxacin or co-trimoxazole were followed-up for 28 days. Treatment failure was defined as re-attendance for symptoms and antibiotic re-prescription, or hospitalisation for UTI complications. After 2:1 propensity score matching in each group, modified Poisson regression and Cox proportional hazard regression accounting for matched data were used to determine risk and time to treatment failure.
results3194 of 4253 (75.1%) UTIs seen were uncomplicated, of which only 26% were diagnosed clinically. Urine cultures were conducted for 1094 (34.3%) uncomplicated UTIs, of which only 410 (37.5%) had bacterial growth. The most common organism found to cause uncomplicated UTIs was Escherichia coli (64.6%), with 92.6% and 99.4% of isolates sensitive to amoxicillin-clavulanate and nitrofurantoin respectively. Treatment failure occurred in 146 patients (4.57%). Among 1894 patients treated with AC + N matched to 947 patients treated with C + C, patients treated with C + C were 50% more likely to fail treatment (RR 1.49, 95% CI 1.10-2.01), with significantly higher risk of experiencing shorter time to failure (HR 1.61, 95% CI 1.12-2.33), compared to patients treated with AC + N.
conclusionTreatment failure rate was lower for antibiotics with lower reported resistance rates (AC + N). We recommend treating uncomplicated UTIs in Singapore with amoxicillin-clavulanate or nitrofurantoin, based on current local antibiograms. Diagnosis, investigations and management of UTIs remained sub-optimal. Future studies should be based on updating antibiograms, highlighting its importance in guideline development.
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