THE MANAGEMENT OF URINARY INFECTION IN WOMEN

Symptoms referable to the lower urinary tract in women are not necessarily due to urinary tract infection, and this should be confirmed by microscopy and culture of urine. Nevertheless, urinary tract infection is common in women after adolescence and may occur in the absence of significant symptoms. Its recognition always justifies investigation of renal function and intravenous pyelography, which together with additional studies such as endoscopy, must certainly be performed when infection is recurrent, clinically severe or slow to respond to therapy. The primary objective of therapy is to accomplish complete and permanent eradication of infection. This requires careful clinical evaluation and investigation to permit a planned approach towards selection of the immediate and subsequent management most suitable for each individual patient. Chemotherapy should always be determined by bacteriological results and suitable precautions adopted for patients with impaired renal function to achieve adequate urinary drug concentrations and reduce the risk of toxicity. Measures to ensure frequent and complete bladder emptying are also important, and urinary tract abnormalities should be surgically corrected whenever possible. The high rate of recurrence of urinary infection often with minimal symptoms indicates that all such patients should undergo regular bacteriological review for at least two years. This period should be extended indefinitely for patients with impaired renal function, structural abnormalities of the renal tract, incomplete response to therapy or recurrent infection.