Antibiotic alternatives, further education and mathematical modelling were some of the topics explored today during the antimicrobial stewardship course (ABS): “From cystitis to urosepsis: What is the best way to deal with antimicrobial resistance (ABS certificates)?”. This course is part of the Joint meeting of the EAU Section of Andrological Urology (ESAU) and the EAU Section of Infections in Urology (ESIU) “When Basic Science meets Clinical Practice” chaired by Prof. Nikolaos Sofikitis (GR) and Prof. Dr. Florian Wagenlehner (DE).
Ass. Prof. Björn Wullt (SE) enumerated various alternatives to antibiotics for treating acute urinary tract infection (UTI) which ranged from observation (“wait and see”), NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) and increased fluid intake (although these require further studies) to Canephron®, a phytotherapeutic medicinal product for which study results will be published soon.
In his lecture “Non-antibiotic treatment and prevention in uncomplicated cystitis”, Wullt also mentioned alternatives to antibiotics for treating prophylaxis of recurrent UTI such as asymptomatic bacteriuria (ABU). He cited a study by Dr. Tommaso Cai (IT) that ABU should not be treated in young women affected by UTI, suggesting it may play a protective role in preventing symptomatic recurrence. Additional alternatives included E. coli 83972, E. coli extract OM-89, and local oestrogen hormone replacement therapy (HRT).
“The best prevention is adequate information,” stated Dr. José Medina-Polo (ES) in his lecture Collateral effects of antibiotic treatment and how to minimise them (C. difficile and multiresistant pathogens. Training focused on multidrug-resistant organisms (MDRO), local microbial prevalence, resistance patterns, and prescription of antibiotics is imperative, as are antimicrobial stewardship programmes dedicated to improving antibiotics. These programmes have demonstrated a reduction in the incidence of infections as well as the isolation of MDRO bacteria and C. difficile infections.
Medina-Polo added that the prescription of antibiotics should be adequately indicated and justifiable in order to avoid the use of broad-spectrum antibiotics. He said that perioperative antibiotics should not be routinely continued beyond the first 24 hours post-surgery unless an infection is present.
“We need to improve antibiotic selection. In this sense, mathematical modelling is a good instrument to deliver that,” said Prof. Zafer Tandoğdu (GB) in his lecture Which antibiotics in what indication: The role of mathematical modelling. “Surveillance studies are highly important to derive that information to summarise the dynamic process which will help us improve our decisions.”