Future approaches to the management of urinary tract infections.

A basic hypothesis running through all of these possible future approaches to the treatment of urinary tract infections is the concept that these infections are first initiated by bacterial adherence to mucosal surfaces in the lower urinary tract and that therapy might be devised to lessen this adherence. This hypothesis represents a basic change from the concept that bacteria enigmatically appear in the bladder and kidneys (possibly as a consequence of obstruction) and that antibiotics must inevitably then be given in ever-increasing dosages and types. The concept of bacterial adherence as the initiating event for most ascending urinary tract infections has allowed a new era of excitement in urologic research and, at the same time, expanded the need for broad collaboration of many other disciplines because of the complexities in the immunology and biochemistry of the adherence process. Although many of these research areas will remain experimental, it is to be hoped that some can be brought into clinical application to help the many patients suffering from these infections.