Does urine therapy improve HIV

Bacteria in the urine: no symptoms, no antibiotic

The sole detection of bacteria in the urine without symptoms, on the other hand, requires no treatment, with a few exceptions. Still, doctors often prescribe an antibiotic. As part of the “Smart decisions” initiative, the DGI has named medical services that are too often or too seldom performed professionally. With the specific recommendations for action that have now been published, the DGI aims to reduce over- and undersupply in infectious diseases, curb the development of resistance and improve patient care.

Routine tests sometimes show bacteria in the urine. "This can have different causes and occurs more frequently in women than in men," says associate professor Dr. med. Norma Jung, senior physician at the Department of Internal Medicine at the University Clinic in Cologne and member of the advisory board of the German Society for Infectious Diseases.

Bacteria in the urine do not require treatment. Therapy should only be initiated when typical symptoms of urinary tract infection, i.e. cystitis, exist.

A precautionary antibiotic treatment does not prevent the symptomatic urinary tract infection from developing from the symptom-free occurrence of bacteria, said Jung. There are only a few defined exceptions to this rule: If bacteria can be detected in the urine during pregnancy or before a urological procedure, doctors should initiate antibiotic therapy even if there are no specific symptoms.

The professional handling of the asymptomatic occurrence of bacteria in the urine is an aspect that the DGI is dealing with as part of the initiative “Smart decisions in infectious diseases”. The initiative “Make smart decisions” was launched in 2014 by the German Society for Internal Medicine (DGIM). Its aim is to identify over- and undersupply in medicine.

For infectiology, one of the sub-specializations of internal medicine, the DGI has formulated five positive and five negative recommendations in a multi-stage process.

"In the first stage, these are aimed at doctors, but also provide patients with helpful information - for example when it comes to starting a certain treatment or not," explains Prof. Dr. med. Gerd Fätkenheuer, Chairman of the DGI and Head of Infectious Diseases at Clinic I for Internal Medicine at Cologne University Hospital.

The negative recommendations, i.e. unnecessary therapeutic measures, also include the treatment of uncomplicated upper respiratory tract infections with antibiotics: In acute upper respiratory tract infections and bronchitis, these cause harm rather than benefit. They do not help against the diseases that are mainly caused by viruses, but they do carry the risk of triggering side effects and fuel the development of resistance. "Upper respiratory infections are one of those diseases for which antibiotics are most often unnecessarily prescribed," says Jung. "There is data for the USA that between 70 and 80 percent of patients who present in a practice or ambulance with an acute respiratory infection are prescribed antibiotics."

In the case of positive recommendations, i.e. measures that make sense but are carried out too seldom, the focus is primarily on prevention, such as carrying out vaccinations in accordance with the requirements of the Standing Vaccination Commission at the Robert Koch Institute (STIKO).

The five positive and negative recommendations that the DGI developed as part of the “Smart decisions in infectious diseases” initiative have now been published in the Deutsches Ärzteblatt:


Jung, Norma, Klug decide:… .in infectiology
Dtsch Arztebl 2016; 113 (13): A-608 / B-514 / C-510

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Contact for journalists:
Juliane Pfeiffer
German Society for Infectious Diseases
Press office
P.O. Box 30 11 20
70451 Stuttgart
Tel: 0711 89 31 693
Fax: 0711 89 31 167
Email: [email protected]

Read the full press release here.

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