Urinary Tract Infection (UTI)
Diagnosis and Conventional Treatment
UTIs may be difficult to diagnose in some cases, since patients may not always have typical symptoms (Wilson 2004). Also, other conditions have symptoms in common with UTI (eg, gonorrhea, chlamydia, interstitial cystitis, and diabetes).
The presence of red or white blood cells, bacteria or certain chemicals in the urine usually indicates a UTI (Fihn 2003; A.D.A.M. 2011). Most frequently, a urine dipstick test is used to confirm the diagnosis of UTI in individuals with suggestive symptoms. This test evaluates a urine sample to detect nitrites, which are chemicals produced by E. coli, a bacteria that can cause UTIs; it also measures levels of proteins produced by immune cells responding to the infection. In some complicated cases, a urine culture may be used to help guide treatment (Wilson 2004).
Antibiotics. The standard treatment for a UTI is a course of one or more antibiotics. No single antibiotic is recommended for treating every UTI, but nitrofurantoin (Furadantin®), trimethoprim-sulfamethoxazole (Bactrim™), pivemecillinam (Selexid®), fosfomycin trometamol (Monurol®), fluoroquinolone (eg, Cipro®), and beta-lactam (eg, Augmentin®) may all be used (Gupta 2012; McKinnell 2011).
Although many antibiotics can be used to treat UTIs, one of the main factors that determines which antibiotics are chosen is the bacterial resistance pattern. There are strains of E. coli that are resistant to antibiotics and are found throughout the world (Hooton 2012; Kahlmeter 2003; Nicolle 2008). Other strains of bacteria that cause UTIs, including species of Proteus and Klebsiella, have also developed resistance to specific antibiotics (Kahlmeter 2003). As a result, the choice of antibiotic is usually governed by susceptibility of the pathogenic organism responsible for an individual’s case and/or community history of microbial antibiotic resistance (Hooton 2012). This is typically determined by regional rates reported by local hospitals, although this information can overestimate the prevalence of resistance among bacteria in a region (Hooton 2012; Gupta 2011a). Some guidelines recommend avoiding a particular antibiotic if local resistance rates to that antibiotic are greater than 20% (Gupta 2011).