Management of uncomplicated urinary tract infections

The majority of urinary tract infections (UTIs) present as bacterial cystitis in women in the sexually active age group. The commonest pathogen is Escherichia coli and the majority of the remainder are due to Staphylococcus saprophyticus. Many women are prone to recurrent UTIs and these are invariably due to a reinfection with a different organism. After the diagnosis has been made a curative course of treatment should be given, but the approach can be modified if the infection is uncomplicated (normal urinary tract and normal renal function) as opposed to complicated. It is widely believed that traditional dosage regiments for uncomplicated UTIs are extravagant. There is now considerable enthusiasm for the use of either single-dose therapy or for a course of treatment not exceeding 3 days for uncomplicated cystitis. Failure of single-dose therapy is a simple guide to the need for further urinary tract investigation or more intensive therapy. Patients with uncomplicated acute pyelonephritis should be treated for at least 5 days and this may need to be given parenterally if the patient is vomiting. If a woman is having recurrent UTIs it may be necessary to consider long-term, low-dose prophylaxis. The most effective drugs used in this way include nitrofurantoin 50 mg, trimethoprim 100 mg and norflaxacin 200 mg given at night. More recent studies have shown that a dose given alternate nights, 3 nights a week of just after intercourse is just as affective.