Hovig B
Kaptein W. Wilhelmsen og frues bakteriologiske institutt, Rikshospitalet, Oslo.
Tidsskr Nor Laegeforen. 1993 Jan 10;113(1):44-6.
Clinical diagnosis can often indicate whether the patient has an infection of the lower or the upper urinary tract. The symptoms may be misleading, however. Examination of the urine is therefore essential. Recommendations are made for sampling, microscopy, stix-tests and interpretation of cultures. Species distribution and sensitivity patterns are presented. There has been a trend towards increasing antimicrobial resistance during the period 1982 to 1990. The recommended drugs for uncomplicated infections of the lower urinary tract in women include nitrofurantoin, amoxicillin, pivampicillin, pivmecillinam, sulfamethizole, trimethoprim and co-trimoxazole, with a possible preference for trimethoprim and nitrofurantoin (should be used with caution in elderly patients). Duration of therapy is normally three days. In pregnant women and in men with an infection of the lower urinary tract the duration of treatment should be 7-10 days. Specific drugs are recommended for these groups of patients. Drugs recommended for infection of the upper urinary tract and complicated infections of the lower urinary tract include amoxicillin, ampicillin, ciprofloxacin/ofloxacin, co-trimoxazole, pivampicillin and pivmecillinam. Duration of treatment should be 7-10 days. Treatment is also recommended for reinfection, for children, for patients with asymptomatic bacteriuria and for patients with permanent bladder catheters. Long-term prophylaxis and general advice on lifestyle are also discussed.
临床诊断通常能够表明患者是下尿路感染还是上尿路感染。然而，症状可能会产生误导。因此，尿液检查至关重要。文中针对样本采集、显微镜检查、试纸检测及培养结果解读给出了建议。还介绍了菌种分布及药敏模式。在1982年至1990年期间，存在抗菌药物耐药性增加的趋势。推荐用于女性单纯性下尿路感染的药物包括呋喃妥因、阿莫西林、匹氨西林、美西林、磺胺甲噻二唑、甲氧苄啶和复方新诺明，其中可能更倾向于使用甲氧苄啶和呋喃妥因（老年患者应谨慎使用）。治疗疗程通常为三天。对于孕妇和患有下尿路感染的男性，治疗疗程应为7至10天。针对这些患者群体推荐了特定的药物。推荐用于上尿路感染和复杂性下尿路感染的药物包括阿莫西林、氨苄西林、环丙沙星/氧氟沙星、复方新诺明、匹氨西林和美西林。治疗疗程应为7至10天。对于再感染患者、儿童、无症状菌尿患者以及长期留置膀胱导管的患者，也建议进行治疗。还讨论了长期预防措施以及关于生活方式的一般性建议。
