An update on the management of urinary tract infection

Abstract

Urinary tract infection (UTI) is commonly encountered in general medical practice. The majority of patients have uncomplicated infections affecting the lower urinary tract, which respond readily to a short course of oral antibiotics. Life-threatening complications or long-term morbidity can occur, especially in patients with underlying medical predispositions or urological abnormalities. Further investigations are warranted in patients with severe or recurrent UTI, or when UTI occurs in 'low risk' individuals. Special investigations to look for vesicoureteric reflux and renal cortical scars should be considered in children with UTI. Screening of pregnant women for asymptomatic UTI is important in view of its propensity to involve the upper urinary tract. A 3-day course of appropriate oral antibiotics is often sufficient for the treatment of uncomplicated lower UTI in young females. A longer treatment duration of up to 7 days may be indicated in elderly subjects. The optimal duration of antibiotic therapy for upper UTI remains controversial. In addition to antibiotic prophylaxis, simple advice on prophylactic measures during activities of daily living is often beneficial to patients with recurrent UTI.