Chapter 28: Urinary Tract Infection – Drug Therapy & Care

The primary mechanism of infection is the ascent of uropathogens, typically Escherichia coli from the digestive tract, into the bladder. Risk factors vary, including anatomical structure, sexual activity, and underlying conditions like diabetes or incomplete bladder emptying. Clinical presentation ranges from asymptomatic bacteriuria to severe pyelonephritis or sepsis, with diagnosis confirmed by specific clinical features (such as dysuria, urgency, or CVA tenderness) alongside positive urine culture results. Pharmacologic management focuses on destroying the organism, relieving symptoms, and preventing complications, relying heavily on antibiotic therapy. Treatment protocols differ significantly depending on whether the infection is classified as uncomplicated (premenopausal, nonpregnant women without structural issues) or complicated (e.g., men, pregnant women, or those with comorbidities). First-line choices for uncomplicated cystitis include nitrofurantoin (preferred due to minimal resistance, requiring a 5- to 7-day course), trimethoprim–sulfamethoxazole (TMP–SMZ), or the single-dose option, fosfomycin. Fluoroquinolones are generally relegated to second-line due to growing resistance and cost concerns. Treatment duration is typically short (1-3 days) for uncomplicated women but must be extended to 7 days or more for pyelonephritis, men, and postmenopausal women. Special patient groups, such as children and pregnant women, require tailored antibiotic selection (e.g., amoxicillin or cephalexin in pregnancy) and specific diagnostic monitoring due to unique risks. Additionally, the chapter addresses adjunctive therapies, like urinary analgesics, and preventative strategies, including postcoital voiding, behavioral changes, and the use of cranberry products or probiotics to manage recurrent UTIs.