Antimicrobial agents in urinary tract infections in patients with spinal cord injury.

Because of the rapid introduction and active marketing of newer antimicrobial agents for urinary tract infections, it is important to evaluate newer antibiotics critically. Critical evaluation should be based on published reports, spectrum of action, and, very importantly, cost. Newer agents should be compared with known effective agents on the basis of hospital antimicrobial sensitivity tests. Simple, uncomplicated urinary tract infections caused by community-acquired multiple drug-sensitive uropathogens can be treated with almost any currently available antimicrobial agent. In these situations, a low-morbidity, low-cost agent with limited dosage should be chosen. In general, a 3-day course of trimethoprim-sulfamethoxazole, nitrofurantoin, a first-generation cephalosporin, a penicillin agent, or in some cases a fluoroquinolone will be both medically and cost effective. For complicated urinary tract infections, more selectivity must be exercised in choosing an appropriate antibacterial agent. In these situations, it is necessary to initiate appropriate diagnostic studies to identify causes and to treat those complications appropriately. The choice of antibiotics must be based on culture results. Initial empiric treatment should be carried out with a broad-spectrum agent of low morbidity. In these complicated infections, fluoroquinolones may be effective with low expected morbidity.