Her urinary tract infections call for different remedies

ON CALL

August 24, 1993|By Dr. Simeon Margolis | Dr. Simeon Margolis,Contributing Writer

Q: Even though my wife is still in her 20s, she has been treated three different times for what her doctor said was an infection of her urinary tract. Could you explain why she was given medications for only a few days the first two times, but with her most recent bout was kept in the hospital overnight, subjected to a number of tests and then told to take antibiotics for two weeks?

A: From your description of the treatments, it is likely that your wife had two different types of urinary tract infections: cystitis on the first two occasions and acute pyelonephritis on the last.

Cystitis, an infection of the bladder, and pyelonephritis, a kidney infection, are most often caused by the same bacteria, %o escherichia coli. Both are common in women because their shorter urethra (the canal through which urine is discharged from the bladder), compared with men's, allows the bacteria easier entry into the bladder.

Cystitis accounts for about 95 percent of doctor visits for a

urinary tract infection (UTI). Its symptoms are a burning during urination along with urgency and more frequent urination. In an otherwise healthy woman who has the typical symptoms of cystitis and no others, the accepted treatment is a three-day course of antibiotics without the need for examination of the urine for bacteria before or after treatment.

Acute pyelonephritis is a more serious type of UTI because the bacteria in the kidney can infect the bloodstream (septicemia) and cause dangerous complications and even death, particularly older individuals and those with underlying severe illnesses. The diagnosis of acute pyelonephritis is suspected in patients with pain in the flank and fever, and confirmed by identification of large numbers of bacteria in the urine. Pyelonephritis is most often cured with two weeks of antibiotic treatment.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.

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