How adequate are the new guidelines on clinical evaluation of bacteriological outcome in uncomplicated UTI?

While the Infectious Diseases Society of Americas guidelines for clinical t rials of antibiotics have proven valuable for defining inclusion criteria i n studies of urinary tract infections, they are far from perfect when it co mes to defining outcome of treatment. This was obvious in a trial comparing a p-lactam antibiotic and a fluoroquinolone for treatment of acute uncompl icated cystitis in women. Depending on how failure was defined in terms of bacterial count and pyuria, failure rates with one and the same regimen var ied between 6 and 67% of patients treated with the beta-lactam. Another fin ding was that pyuria measured with microscopy of urine sediment was a highl y unreliable technique. Systematic studies are needed to define the optimal criteria for measuring outcome in these infections. (C) 1999 Elsevier Scie nce B.V. All rights reserved.