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New Treatments for Bladder Infection and Kidney Infection

We see a common preponderance of UTI's in females, with a 20 to 1 ratio of female cases to male cases. I found it unusual that one urinary tract infection caused $140 and I guess that divides up the number of more expensive approaches among those who don't use such expensive methods bladder infection or kidney infection. Annual health care costs one billion dollars and I would rather not throw away one billion dollars if we don't have to. I have some points here that I call newer concepts; they are hardly radical thoughts, but it is important to keep in mind that a third of women who have a bladder infection do not have a classic positive bladder culture. Unfortunately, that has also been the basis for a lot of empiric treatment with antibiotics.

E. coli is the predominant offender here. Other bacteria of that class make up ninety percent of urinary tract infections and Staphylococcus saprophyticus makes up a preponderance of the remainder. These are routine, community-acquired infections. Pseudomonas aeruginosa is what I see if I have a catheter patient who really gets a bad infection at the time of hospitalization.

Risk factors for urinary tract infection pretty much relate to impaired bladder emptying when we try to objectively measure them. Advanced age goes along with hypoestrogenism, which is also in a sense an independent risk factor, but inefficient bladder emptying can occur as a result of any of a number of things; a large cystocele or neurogenic voiding dysfunctions, not necessarily associated with obvious neurologic disease, but with idiopathic failure of bladder contractility.

Moving on to simple treatment, pretreatment cultures are not necessary, they are not cost effective and very often I will prescribe a short course of therapy that would be almost completed pretty much before even a rapidly evaluated culture is returned. We will talk about what complicating factors are that may cause you to want to prolong your treatment. Most uncomplicated cystitis can be treated with three days of therapy.

The treatment recommended for simple, uncomplicated urinary tract infection is three days of trimethoprim, Bactrim or Macrodantin can be a very useful way to see if that person responds and further evaluating them if they do not improve. Complicated urinary tract infections, people who need longer duration of treatment, are people who have shown resistance.

In complicated urinary tract infections, the microbiology is a little different. E. coli is only about one third; the remainder of the enterobacteraciae are about one third and you have an increase in enterococcus and staphylococcus of about one third. In this group, 10 to 14 days of treatment with the quinolones, such as Cipro, would be recommended therapy.

In pyelonephritis, E. Coli is still the predominant initiating organism; we know it could be a polymicrobial infection with advanced disease. If somebody has fever, upper tract symptoms and they are not really septic and are functioning well, you can go with out-patient therapy. Certainly, hospitalization is required for the more sick patient.

In the issue of recurrent infection, when you truly have the same organism isolated throughout the treatment, when it doesn't go away, when you don't effectively eradicate it at all from the urinary tract, this is where you get concerned about a structural functional abnormality. Then these other issues play into it that are totally benign and you don't do an IVP or cystoscopy to find these people. You do a culture and make sure that you are using the right antibiotic. As few as two urinary tract infections a year are sometimes called frequent. I generally find that by the time people have four or five, they have fallen into a potential problem with this category.