Urinary tract infections. 2. Therapeutic approach.

Acute urethral syndrome is effectively treated with a standard course of an appropriate oral antibiotic. Cystitis can be treated similarly but, because it is regarded as benign in normal hosts, may be better treated symptomatically. Acute pyelonephritis requires a parenteral antibiotic because of its frequent association with bacteremia. In chronic pyelonephritis, an oral antibiotic is chosen for long-term use on the basis of its ability to penetrate damaged renal tissue. When urinary tract infection recurs, reinfection must be differentiated from relapse. Reinfection usually requires long-term antimicrobial therapy, but relapse often has a potentially reversible underlying cause and merits extensive diagnostic workup. Chronic prostatitis constitutes a greater therapeutic problem than acute prostatitis because of difficulty with antibiotic penetration.