Management of biofilm infections in the urinary tract.

Bacterial biofilms develop on a number of living and inert surfaces within the urinary tract, producing chronic intractable infections. The role of exopolysaccharides in producing a variety of extracellular polymeric substances according to the infection site and bacterial species and the clinical features of the resulting biofilm infections were reviewed. Although fluoroquinolone shows a considerable killing effect against bacterial biofilm, no commercially available drugs are sufficiently active against the cells in a mature biofilm. Combination therapy of fluoroquinolone and macrolide or fluoroquinolone and fosfomycin may be the most effective regimen available at present. Nevertheless, management of the local urinary condition and removal of the local underlying disease are the most effective approaches to treating urinary biofilm infection.