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Avoid common mistakes when treating UTIs.

PALM BEACH, FLA. -- Treating urinary tract infections based on urine culture results alone is a common mistake, Dr. Stanley W. Chapman said at a meeting on infectious diseases sponsored by the Southern Medical Association.

"There are physicians who respond to the urine culture only. They do not look at the patient or other factors, just bacteremia," said Dr. Chapman, chief of infectious diseases and professor of medicine and microbiology at the University of Mississippi, Jackson.

Assess patients for systemic infection, he advised. "Some physicians treat, even though there is no pyuria, no hematuria, no evidence of an ongoing inflammatory response, and patients are afebrile."

But keep in mind that treatment of asymptomatic bacteriuria is indicated before procedures with a high risk of infection, such as prosthetic joint surgery. "An undiagnosed urinary tract infection is often a problem afterward," Dr. Chapman said.

Another common error is failure to distinguish complicated from uncomplicated urinary tract infections (UTIs)--an important distinction that guides therapeutic decisions. Upper tract infections are complicated, for example, and can affect the kidney and cause polynephritis. Patients with a complicated infection may require hospitalization and a longer course of therapy than patients with uncomplicated infections.

In certain patients, a UTI should automatically be considered complicated. These include pregnant women, men (because of possible prostatitis), and immunocompromised patients.

Most UTIs in young, sexually active women are uncomplicated. These patients have no systemic signs of infection but can have lower tract symptoms, such as cystitis and urethritis. Most uncomplicated infections respond to 1-day or 3-day regimens. Although the response rate is higher with 3-day therapy (94% efficacy) than with 1-day (85% efficacy), there is a tradeoff of more adverse events with longer therapy (Clin. Infect. Dis. 1999;29:745-58). "Whether you use 1 or 3 days is a matter of personal preference," Dr. Chapman said.

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Title Annotation:Infectious Disease; urinary tract infections
Author:McNamara, Damian
Publication:Family Practice News
Geographic Code:1U5FL
Date:Nov 15, 2004
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