[Summary of the 'Urinary tract infections' guideline (first revision) of the Dutch College of General Practitioners]

Abstract

The important changes in the Dutch College of General Practitioners' revised guideline on urinary tract infections, with respect to the first edition, are as follows: In assessing a urine sediment the leucocyte count has been omitted due to its low specificity. In the case of a negative nitrite test, the number of bacteria is of diagnostic importance. If a microscopic count is difficult to carry out, a semi-quantitative culture with a dip-slide is a good alternative. In the case of uncomplicated urinary tract infections, nitrofurantoin or trimethoprim are the preferred antibiotics, whereas for pregnant women nitrofurantoin and amoxicillin without clavulanic acid should be used. The most important pathogen is often resistant to sulphonamides. In the case of complicated urinary tract infections, characterised by fever, and a still unknown sensitivity of the pathogen, amoxicillin-clavulanic acid is recommended except in the case of pregnant women. The usefulness of tracing and treating pregnant women with asymptomatic bacteriuria has yet to be demonstrated.