Recommended for empirical treatment in case of initial failure or for severe cases

- Fluoroquinolone (if not used for initial therapy)

- Ureidopenicillin (piperacillin) plus a BLI

- Cephalosporin (group 3b)

- Carbapenem

- Combination therapy:

• Aminoglycoside + (3-lactam antibiotic

• Aminoglycoside + fluoroquinolone

Not recommended for empirical treatment

- Aminopenicillins, e.g. amoxicillin, ampicillin

- Trimethoprim-sulphamethoxazole (only if susceptibility of pathogen is known)

- Fosfomycin trometamol

5.4.7 Follow-up after treatment

The greater likelihood of the resistance of micro-organisms involved in complicated UTIs is another feature of these infectious diseases. This is not a priori related to the urinary abnormality, but more to the fact that patients with a complicated UTI tend to have recurrent infection (7). For these reasons, prior to and after the completion of the antimicrobial treatment, urine cultures must be obtained for the identification of the micro­organisms and the evaluation of susceptibility testing.

Conclusions

Until predisposing factors are completely removed, true cure (i.e. without recurrent infection) is usually not possible. Correction of these abnormalities must be performed, whenever possible, as an essential part of treatment. Recurrent infection is the rule when the underlying urological abnormality cannot be removed: either relapse (e.g. with the same micro-organism) or a re-infection (e.g. with a new micro-organism). For this reason, a urine culture has to be carried out 5-9 days after the completion of therapy and also 4-6 weeks later.

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