Urinary tract infection: emerging insights into appropriate management

Urinary tract infection remains an important health concern, particularly in women. It is important to differentiate between uncomplicated and complicated infections, because management strategies differ. Women 18 to 65 years of age with manifestations of uncomplicated lower urinary tract infection can be safely and effectively treated with a 3-day course of trimethoprimsulfamethoxazole (Bactrim, Cotrim, Septra) or trimethoprim alone (Proloprim, Trimpex) if pyuria is detected on urinalysis. Patients with any other manifestations require further diagnostic testing and more prolonged therapy. Urine cultures should be obtained only in patients with complicating factors, and urologic evaluation is warranted only if clearly indicated. Recurrent infection may require continuous antimicrobial prophylaxis. Catheter-related infection should be treated only if the patient is symptomatic. Infection in men may require 4 to 6 weeks of therapy because of possible prostatic involvement.