Urinary tract antiseptics

The urinary tract antiseptics discussed herein have specific advantages and disadvantages. All share a pharmacokinetic fate that makes them effective in treating acute, uncomplicated symptomatic bladder bacteriuria. Nitrofurantoin appears to be the most versatile because it is effective against upper tract infection, recurrent bacteriuria, and as a long-term suppressive agent in children and pregnant patients with only a low incidence of the development of resistance. Methenamine, when used with proper understanding of it pharmacokinetic behavior, is also effective in females with uncomplicated recurrent bacteriuria including those with multiply resistant pathogens, as well as a prophylactic agent in males with recurrent infection. There is little evidence that methenamine combined with mandelic or hippuric acid confers any pharmacologic or therapeutic advantage over the use of methanamine base alone. Nalidixic acid and oxolinic acid, in addition to effectiveness in treating uncomplicated acute lower urinary tract infections, may be effective in some patients with recurrent infections, but requires careful sensitivity monitoring of pathogens for the development of resistance. Finally, in a society whose economic pressures are such that it may not be cost-effective to use sulfamethoxazole-trimethoprim for urinary tract prophylaxis--unless two or more acute infections occur per year--the use of these urinary antiseptics may offer increasing advantages now and in the future.