Clinical management of urinary tract infection.

The clinical management of urinary tract infection has changed considerably over the last two decades due to the recognition of several important factors: All urinary tract infections are not the same; in particular, deep tissue infection of the kidney and/or prostate requires a very different form of clinical management than does superficial mucosal infection of the bladder. Consistent with these differences, it is now clear that conventional 7-14 day treatment courses are not ideal for most forms of urinary tract infections; deep tissue infection requires more intensive therapy and superficial mucosal infection needs less intensive therapy. In particular, single dose antimicrobial therapy has been a major advance in the management of the most common form of urinary tract infection--acute uncomplicated urinary tract infection of the adult female; such therapy is safe, effective, inexpensive, and the response provides useful clinical information. The recognition of the etiology of the acute urethral syndrome in most patients (true bacteriuria or Chlamydia trachomatis infection) had led to an effective therapeutic approach to this problem. A logical approach to the problem of recurrent urinary tract infection has emerged that is both cost-effective and clinically effective. Finally, a clearer picture of those populations that would benefit most from anatomical study of the urinary tract has been developed. With these advances, this most common of bacterial infections affecting man throughout his lifespan has become much easier to control.