Medical Associates Clinic

 Quality Care Close To Home

     Next to upper respiratory tract infections, which include both viruses and bacteria, the second most common infection in humans is a bacterial infection of the urinary tract.  It is estimated that 50% of all woman will have at least one urinary tract infection in their lifetime.  Fortunately, most of these infections will involve only an infection of the bladder and can be easily treated with a three-day course of antibiotics.  However, there are a number of considerations that complicate urinary tract infections.

     Perhaps the most commonly misunderstood group is elderly woman who have “colonization” of their bladder but not truly and infection.  Because woman have a short tract from the inside to the outside of their bladder, they are much more prone to an infection than men.  By the same token, after multiple childbirths and the loss of estrogen conditioning of the urethra, bacterial colonization of the elderly woman’s bladder is very common.  This does not require antibiotic therapy and in fact, antibiotics cause complications.

     The problem with treating colonization of the bladder in elderly woman involves a selection of antibiotic resistant bacteria.  A woman may have an infection with very susceptible bacteria but is then treated with an antibiotic.  However, because the reinfection of her bladder frequently follows, a more resistant organism then takes its place.  As this sequence proceeds through two or three or four antibiotics, a very resistant organism is then selected.  Then when a significant bacterial infection occurs from the colonization, there are no good antibiotics to treat it with.  Thus, unless the lady is having definite symptoms of urinary tract infection, it is not advisable to treat with antibiotics simply because there are bacteria growing in the urine.

     The story is different in pregnant women.  While a lady is pregnant, having the bladder sterile is a definite indicated step and antibiotic treatment is indicated in that situation.

     In men, the story is different.  Urinary tract infections in men are very unusual and usually involve an anatomic abnormality such as prostatitis, bladder stones, or kidney stones.  A urinary tract infection in a man requires an evaluation the first time the infection occurs.

     While most urinary tract infections involve only the bladder, there are a few that involve the migration of the bacteria up the ureter to the kidney.  When this occurs, there is a much more serious situation and several weeks of antibiotic therapy are required.

     In the past, penicillin and sulfa antibiotics were the most commonly used products.  More recently a new family of antibiotics called ciprofloxacin (Cipro), levofloxacin (Levaquin) and ofloxacin (Floxin) have superseded the older antibiotics.  The older antibiotics have almost a 10% incidence of allergic reactions, which are really very unusual with the new family of antibiotics.

     Patients often look upon coming to the clinic to get a urine culture as a nuisance.  The first time that a lady has a urinary tract infection, cultures are probably not necessary.  However, if a lady has a secondary urinary tract infection or any man who has a urinary tract infection, cultures of the urine are an important step to identify the organization and be sure that appropriate antibiotic treatment is obtained.

     Patients who have diabetes or ladies who are pregnant or patients with polycystic kidney disease, multiple sclerosis or anatomical abnormalities of their urinary tract provide a special population that requires careful medical attention.  The local clinics are well aware of the potential complications from urinary tract infections and those patients who require further evaluation.