Urinary infections in adults: clinical approach and therapeutic indications

Urinary tract infections (UTI) are the most common of all the bacterial infections affecting humans during their life span. In adult patients, UTI may be categorized into the following groups: acute uncomplicated cystitis, acute uncomplicated pyelonephritis, recurrent bacterial UTI infections, asymptomatic bacteriuria, complicated UTI, acute and chronic bacterial prostatitis. In patients with uncomplicated cystitis, short-course (3 days) empirical therapy is more effective than single dose therapy. Recurrent cystitis can be effectively managed by continuous antimicrobial prophylaxis. Acute pyelonephritis in patients with anatomically normal urinary tracts should be treated with antimicrobial therapy for 10 to 14 days. Complicated infections require a full 10- to 14-day course of antimicrobial therapy. Urologic evaluation in patients with acute pyelonephritis or recurrent infections should not be routinely performed. Screening for asymptomatic bacteriuria is unnecessary in adults, except in particular circumstances. There is little evidence that UTI in adult patients lead to progressive chronic renal injury, unless complicating factors are concurrently present.