Treatment of urinary tract infections

Tactics of patient management

Many experts recommend that all patients with suspected urinary tract infection to conduct urine culture to determine the sensitivity of pathogens to antibiotics. However, for women with a typical pattern of primary acute cystitis, or as we call it inflammation of the lower urinary tract, it is wiser and cheaper to use a different tactic.

Some doctors prescribe empirical treatment based solely on historical and physical findings. Others prefer to first conduct a microscopy of urine (or the determination of leukocyte esterase using test strips).

Detection of leukocyturia or bacteriuria proves the presence of an infection, after which empirical treatment can be prescribed. Urine culture and determining the sensitivity of the pathogen in this case are not needed. If the results of urine tests call into question the diagnosis of cystitis, urine culture is highly recommended.

In the treatment of urinary tract infections, the physician is usually guided by the following principles:

  1. In most cases, prior to the start of treatment, the diagnosis is confirmed using urine culture, Gram-stained urine smear or rapid diagnostic methods; after a few days, the treatment, if necessary, is changed, based on the detected sensitivity of the pathogen.
  2. Exclude and, if possible, eliminate factors contributing to infection (urinary tract obstruction, urolithiasis).

The results of treatment

Effective Guideline for Cystitis Treatment

are regarded as failure (absence of improvement or preservation of bacteriuria during or immediately after the end of treatment) or as a cure (disappearance of symptoms and bacteriuria).

In the case of relapse, recurrent and recurrent infections are differentiated, and relapse is also referred to as early (within 2 weeks after the end of treatment) or late.

Primary infections of the lower urinary tract, in the overwhelming majority of cases, respond well to short courses of antimicrobial therapy, whereas for infections of the upper urinary tract, longer treatment is required.

Early relapses are usually recurrent infection and are caused either by the survival of the pathogen in the upper urinary tract or by the continued dissemination of intestinal microflora (especially after short courses of treatment of cystitis). Late relapses are almost always re-infection.

Pathogens of community-acquired urinary tract infections, especially infections that have occurred for the first time, are usually susceptible to antibiotics.

Frequent recurrences of recent hospitalization lead to suspicion of infection caused by resistant pathogens.

The result of treatment is largely determined by the localization of the infection. Acute cystitis is usually cured by any drug to which the pathogen is sensitive. It has long been proven that bacteriuria in patients with acute cystitis disappears after a single dose of an antimicrobial drug.

However, with pyelonephritis, not only a single dose, but even a 7-day course of treatment is often not enough. In some cases, the source of infection can be eliminated only after 2-6 weeks of antimicrobial therapy.

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