Useful agents in the management of urinary tract infections

Urinary tract infections (UTIs) encompass a large variety of clinical conditions ranging from asymptomatic bacteriuria in healthy individuals to life-threatening bacteraemic infections. The choice of antibiotic therapy must be based on identification of the type of UTI to be treated, possible contraindicating factors with the individual patient and, above all, knowledge of the antibiotic resistance pattern in the geographical area where the patient acquired the bacteriuria. In many countries trimethoprim-sulphonamide combinations, trimethoprim plain or nitrofurantoin are still useful drugs. Generally, the clinical efficacy of oral beta-lactams such as amoxicillin, ampicillin and cephalosporins seems to be less good than those of fluoroquinolones and the above-mentioned antibiotics. However, too frequent use of quinolones may lead to increased frequencies of resistance to those antibiotics in common species such as Escherichia coli. It is therefore recommended not to used fluoroquinolones in patients with sporadic uncomplicated cystitis, i.e., the most common type of UTI, but to reserve the modern quinolones for patients with pyelonephritis, complicated UTI or recurrent UTI.