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Urinary tract infection (UTI) is one of the most common bacterial infections encountered in clinical practice in Europe and North America. It is estimated that 150 million cases of UTI occur on a global basis per year resulting in more than 6 billion dollars in direct health care expenditure1. Young, otherwise healthy, women are commonly affected with an estimated incidence of 0.5?0.7 infections per year2. Of the women affected 25?30% will go on to develop recurrent infections not related to any functional or anatomical urinary tract abnormality. Escherichia coli are the causative pathogen in pproximately 70% to 95% and Staphylococcus saprophyticus in approximately 5% to 10% of acute uncomplicated cystitis. Occasionally other Enterobacteriaceae, such as Proteus mirabilis, Klebsiella sp, enterococci, or group B streptococci, are isolated from such patients. A similar distribution of uropathogens is found in acute uncomplicated pyelonephritis. The therapy of uncomplicated UTIs is almost exclusively antibacterial, whereas in complicated UTIs the complicating factors have to be treated as well. There are two predominant aims in the antimicrobial treatment of both uncomplicated and complicated UTIs: (1) rapid and effective response to therapy and prevention of recurrence of the individual patient treated; (2) prevention of emergence of resistance to antimicrobial chemotherapy in the microbial environment. This article focuses on the current management of women with acute uncomplicated cystitis and pyelonephritis.
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