[The Dutch College of General Practitioners' guideline on urinary tract infections: response from the viewpoint of internal medicine].

In 1999 the Dutch College of General Practitioners (NHG) and the Dutch Institute for Healthcare Improvement (CBO) published revisions of their guidelines on urinary tract infections. Contrary to previous editions, the revised guidelines agree on most points, but not all. To diagnose a urinary tract infection in non-pregnant women with dysuria, the NHG guideline advises a nitrite test and a dip-slide culture if the nitrite test is negative. Although the dip-slide improves the diagnostic accuracy, a considerable number of patients have to wait at least 24 hours before therapy is given. The diagnostic approach of the CBO guideline uses only rapidly available test results, with the consequence that some women are treated despite not having an infection. The NHG guideline advocates the use of amoxicillin or nitrofurantoin for pregnant women. Amoxicillin is a questionable choice given that about 30% of isolates are resistant to it. Nitrofurantoin is in theory a correct choice. However, it is not registered for the treatment of complicated urinary tract infections. In the CBO guideline amoxicillin-clavulanic acid is considered to be sufficiently safe for the treatment of pregnant women because most urinary tract infections occur after the first trimester.