[Antimicrobial therapy of urinary tract infections]

Abstract

Urinary tract infections (UTIs), according to localization of infection, can be subdivided into urethritis, cystitis, prostatitis and pyelonephritis, according to type of infection into symptomatic, asymptomatic, acute (first or single), recurrent, chronic, complicated and uncomplicated. Clinical symptoms of cystitis and leukocyturia are sufficient reason for early initiation of a three-day empirical antimicrobial therapy of acute uncomplicated cystitis in young women. Urine culture should be performed prior to the initiation of antimicrobial therapy in pregnant women, diabetics, recurrent UTIs, in case of unsuccessful prior treatment and in patients with pyelonephritis. All symptomatic UTIs should be treated, as well as asymptomatic bacteriuria in pregnant women, diabetics, preschool children and prior to urologic-gynecologic surgery. In complicated UTIs it is especially important to determine and try to eliminate or at least put under control the factors that complicate UTIs. Antimicrobial therapy of UTIs includes fluoroquinolones, co-trimoxazole, betalactam antibiotics, aminoglycosides and nitrofurantoin, tetracyclines, macrolides, and azalydes in case of sexually transmitted diseases caused by Chlamydia trachomatis and Ureaplasma urealyticum. Cystitis is treated for 1, 3 or 7 days, asymptomatic bacteriuria 3-7 days, uncomplicated pyelonephritis 10-14 days, bacterial prostatitis 4-8 weeks, and chronic nonbacterial prostatitis 2-4 weeks. Recommended therapy for chronic and complicated UTIs is 7-14 days only in relapses and reinfections, and in some patients it can last for several weeks, up to 6 months. Chemoprophylaxis in recurrent uncomplicated UTIs should be employed for at least 6 months.