Diagnosis and treatment of uncomplicated urinary tract infection

Acute uncomplicated urinary tract infection is one of the most common problems for which young women seek medical attention. Most episodes of acute uncomplicated cystitis are caused by Escherichia coli, which is susceptible to many oral antimicrobials. Short-course antimicrobial therapy is effective, but single-dose regimens seem to be less effective than 5-day regimens, Seven-day regimens are indicated if amoxicillin, first generation cephalosporins, or nitrofurantoin are used. Acute uncomplicated pyelonephritis, which is an upper tract infection caused by highly virulent uropathogens in an otherwise healthy woman, is optimally treated with a 10- to 14-day regimen of antimicrobials that attain high renal tissue levels. Many such patients can be safely and effectively managed as outpatients. Acute uncomplicated cystitis or pyelonephritis in healthy adult men is uncommon but is caused by the same spectrum of uropathogens with the same antimicrobial susceptibility profile as that seen in women.