Durée de traitement des infections urinaires

The incidence of urinary tract infections in France is estimated at 4 to 6 million per year, and is one of the leading causes of bacterial infection. Treatment of these infections represents 12 % of total antibiotic prescriptions and has an important environmental impact on commensal flora. Short-term use of antibiotics could limit this impact, minimize the risk of adverse effects, enhance compliance and reduce treatments costs. However, a too short treatment could lead to relapses. For uncomplicated acute cystitis, several antibiotics have seen validated for short treatments: fosfomycine, fluoroquinolones and cotrimoxazole as single dose treatment. Treatment fluoroquinolones et cotrimoxazole for 3 days, nitrofurantoin for 5 days. In complicated cystitis, due to the lack of data in the literature, it is not recommended to prescribe short treatments or single dose treatment. A short treatment for uncomplicated acute pyelonephritis may be considered with fluoroquinolones (ciprofloxacin, ofloxacin, levofloxacin) for 7 days. Seven days is also an option when initiating therapy with parenteral third-generation cephalosporin followed by a fluoroquinolone. The effectiveness of other antibiotics for 7 days was not demonstrated. Treatment duration of 14 days has been validated for cotrimoxazole. The results of open-label studies show that a treatment duration of 10 days, for cotrimoxazole susceptible bacteria seems adequate. The treatment duration of complicated a cute pyelonephritis cannot be shortened in the absence of evidence from the literature. The treatment duration of acute prostatitis is not consensual because of the lack of randomized data; however, a 10-day treatment in young men (< 50 years) with non-severe prostatitis and 21 days otherwise seems reasonable.