Management of Urinary Tract Infections

Abstract

In recent years, pronounced progress in the management of urinary tract infections has been made primarily because of three factors :

1. A more complete investigation of the urinary tract to rule out the presence of coexisting pathological conditions. The ease with which this may be accomplished has been facilitated greatly since the introduction of intravenous urography.

2. A thorough bacteriological study, including a stained smear of the sediment and such cultural investigations as are deemed necessary to classify the organism. In certain instances, additional cultural studies should be made to determine certain properties which may be possessed by the various organisms, such as the power of splitting urea.

3. The introduction of the newer chemotherapeutic agents. Since sulfanilamide and mandelic acid have been made available, numerous drugs which have been employed in the treatment of urinary tract infections in the past have been discarded and the management of such infections has been placed on a strictly scientific basis.

Although the type of organism present definitely influences the choice of drug to be prescribed, additional conditions merit consideration before mandelic acid or sulfanilamide are used. In the aged, the blood urea and carbon dioxide should be studied frequently as acidosis may result from the administration of mandelic acid. The use of sulfanilamide may produce a similar result, but with the simultaneous administration of sodium bicarbonate, it occurs to a lesser degree.

With impairment of renal function, further depression of function may follow the use of either drug, and concentration of. . .