Recurrent urinary tract infections in female patients: an overview of management and treatment.

Several major factors have contributed to the current availability of highly successful techniques for the management of recurrent urinary tract infection (UTI) in female patients. Since UTI cannot be diagnosed by symptoms alone, greater accuracy in diagnostic techniques that establish whether bacteria in the voided urine are present in the bladder urine is the most important factor. Second, the recognition that almost all recurrent UTIs are reinfections is crucial. Third, it has been observed that bacteriuria in female patients is preceded by colonization of the introital mucosa of the vagina and urethra with Enterobacteriaceae from the rectal flora; it is at these sites that oral antimicrobial agents can determine the character of subsequent reinfections of the urinary tract. A fourth factor is the development of highly effective prophylactic regimens, including trimethoprim-sulfamethoxazole, nitrofurantoin, cinoxacin, and cephalexin. In addition, the management of patients with UTI has improved because correctable causes of bacterial persistence are now well recognized and there is an improved understanding of the kinds of patients at increased risk. Finally, new antimicrobial agents with more favorable pharmacokinetic properties have become available.