A PRACTICAL GUIDE TO THE MANAGEMENT OF COMPLICATED URINARY-TRACT INFECTION

Complicated urinary tract infections are infections in the setting of structural or functional abnormalities of the genitourinary tract. The y encompass a wide variety of clinical syndromes and anticipated outco mes. The infecting microorganisms isolated are more varied and demonst rate a higher prevalence of antimicrobial resistance in complicated co mpared to uncomplicated urinary tract infections. The usual duration o f therapy is 7 to 14 days, although comparative trials to define optim al treatment duration are lacking. Long term success of antimicrobial treatment is dependent upon whether or not the underlying genitourinar y abnormality can be corrected. Treatment of complicated urinary tract infections will usually be successful and may be permanent if the und erlying abnormality can be corrected. If the underlying abnormality ca nnot be corrected, failure rates of 50% at 4 to 6 weeks following ther apy are expected. Antimicrobial agents are similar to those used to tr eat uncomplicated urinary tract infection. Certain agents, such as nit rofurantoin, should be avoided for individuals with renal failure. No specific agent or class of agents has consistently demonstrated greate r therapeutic efficacy where the infecting organism is susceptible to the given agent.