‘It is important to treat urinary tract infections effectively, especially in younger women. The development of acute pyelonephritis during pregnancy can be a cause of fetal morbidity’

Acute and chronic urinary tract infections are important and avoidable sources off ill health among women. The short urethra, which is prone to entry of bacteria during intercourse, poor perineal hygiene and the occasional inefficient voiding ability of the patient and unnecessary catheterizations are all contributory factors. Post-menopausal atrophy and change in vaginal pH may predispose to recurrent urinary tract infection (UTI) due to vaginal colonization of coliform bacteria.

A significant urinary infection is defined as the presence of bacterial count of the same organism/ml of freshly plated urine. On microscopy, there are usually red blood cells and white blood cells. The common organisms are Escherichia coli, Proteus mirabilis, Klebsiella aerogenes, Pseudomonas aeruginosa and Streptococcus faecalis. These gain entry to the urinary tract by a direct extension from the gut, lymphatic spread via the bloodstream or transurethrally from the perineum. Symptoms include pain on micturition (dysuria), frequency and occasionally bloody urine (haematuria). Loin pain and rigors and a temperature above 38oC usually indicate that acute pyelonephritis (inflammation of the parenchyma of the kidney) has developed.

A urine microscopy, culture and sensitivity of midstream specimen is required. Intravenous or CT urography or renal ultrasonography may be required in patients with recurrent infection to define anatomical or functional abnormalities.

Antimicrobial therapy can be commenced in acute urinary infection once a midstream specimen has been sent for culture and sensitivity. The regimen can be changed later according to the result of urine culture and sensitivity. Commonly used drugs include trimethoprim 200mg twice daily or nitrofurantoin 100mg 4 times daily or a cephalosporin.

Recurrent urinary tract infection for which an identifiable source has not been found may be managed by long-term low-dose. Antimicrobial therapy such as trimethoprim. Recently, ciprofloxacin and norfloxacin have proved effective. There is sound evidence that vaginal oestrogen treatment can reduce recurrent urinary infection in post-menopausal women.

It is important to treat urinary tract infections effectively, especially in younger women. The development of acute pyelonephritis during pregnancy can be a cause of fetal morbidity.