Nicolle Lindsay E
Department of Medical Microbiology and Internal Medicine, University of Manitoba, Health Sciences Centre, Winnipeg, MB, Canada.
Int J Antimicrob Agents. 2008 Feb;31 Suppl 1:S40-5. doi: 10.1016/j.ijantimicag.2007.07.040. Epub 2007 Nov 26.
The pharmacokinetic characteristics of some antimicrobials lead to very high urinary concentrations. This, together with the superficial nature of bladder infection and effective voiding, supports the use of short-course antimicrobial therapy for treatment of acute uncomplicated cystitis. Even a single dose is effective for >90% of episodes for some antimicrobials. Short-course therapy for 3 days is, however, the current accepted standard of therapy for acute uncomplicated urinary tract infection (UTI). Complicated UTI is a more diverse clinical entity. For individuals with some underlying abnormalities, including incomplete drainage of urine or renal failure, short-course therapy is never appropriate. However, some individuals with complicated UTI have adequate urinary emptying, infection limited to the bladder and normal renal function. For these persons, the same principles that promote effective short-course therapy for treatment of acute uncomplicated UTI should also apply. However, clinical studies reported to date do not support the use of short-course therapy for treatment of complicated cystitis. Further studies enrolling well-characterised patient populations with consistent clinical presentations are required to define the role, if any, of short-course therapy in complicated UTI.
某些抗菌药物的药代动力学特征会导致尿液中的药物浓度非常高。这一点，再加上膀胱感染的表浅性质以及有效的排尿，支持采用短程抗菌治疗来治疗急性单纯性膀胱炎。对于某些抗菌药物而言，即使单次给药对超过90%的病例也是有效的。然而，3天的短程治疗是目前公认的急性单纯性尿路感染（UTI）的治疗标准。复杂性UTI是一种更为多样的临床病症。对于一些存在潜在异常情况的个体，包括尿液引流不畅或肾衰竭，短程治疗绝不合适。然而，一些复杂性UTI患者的尿液排空正常，感染局限于膀胱且肾功能正常。对于这些人，促进有效短程治疗急性单纯性UTI的相同原则也应适用。然而，迄今为止报道的临床研究并不支持使用短程治疗来治疗复杂性膀胱炎。需要开展进一步的研究，纳入临床表现一致且特征明确的患者群体，以确定短程治疗在复杂性UTI中的作用（如果有）。
