Urinary infections are complex and hard to treat

Lower urinary tract symptoms in women are non-specific and continue to confound clinicians. Kronenberg and colleagues have demonstrated that the use of NSAIDS to treat urinary tract infection (UTI) symptoms can result in resolution by day 3 for half of the participants but comes at a clinical cost. The NSAID group initiated rescue antibiotics by day 3 (41%), had positive urine cultures within 30 days (28%), required reconsultation for UTI (20%), and developed pyelonephritis (5%). (Kronenberg et al. BMJ 2017;359).

Our group endorses the need for research that improves our definition, detection and treatment of UTI. The current, simplistic dichotomous definition of UTI should be re-evaluated given the new knowledge of the urinary microbiota (referred to as the microbial soup by Professor Malone-Lee) (Malone-Lee BMJ 2017;359). The emerging evidence that the symptoms attributed to UTI vary across affected individuals is an often ignored, but important, clue that should prompt researchers to question the etiology of these symptoms. In addition, these findings should prompt clinicians to suppress the urge to prescribe UTI antibiotics without sufficient justification or evaluation of efficacy and collateral effects of systemic antibiotics (often repetitively).

The world of UTI goes well beyond the frequently cultured E. coli and the few other well-known uropathogens. We are capable of improving on empiric treatment algorithms and a 50+ year old system of urine cultures and/or dipstick analyses. As difficult as it is for clinicians to step away from such the simplistic current treatment algorithm for UTI, it is essential that we utilize the available evidence to inform and improve clinical care for those affected.