Urinary tract infection in women. New perspectives on office management

Symptomatic urinary tract infection is a common complaint in women. A convenient classification of such infection is bacterial pyelonephritis, bacterial cystitis, and "urethral syndrome," on the basis of symptoms and urine culture colony count. Pyelonephritis can be treated in the office if the patient is not toxic, follow-up is possible, and the patient can tolerate oral medication. Treatment commonly is given over a period of two to six weeks. Single-dose therapy is now the preferred treatment for bacterial cystitis, and several agents are effective. When an infectious agent can be identified in urethral syndrome, antibiotic therapy is useful. Patients in whom an agent cannot be identified may be found to have interstitial cystitis. Recurrence can be a matter of relapse but usually results from reinfection. The causes of relapse usually can be approached surgically, while reinfection must be treated with behavior modification and prolonged antibiotic prophylaxis.