Urinary tract infections are caused by direct invasion by bacteria (rarely by fungi, protozoa, and viruses). Urinary tract infections are divided into upper and lower urinary tract infections. Upper urinary tract infections refer to pyelonephritis and lower urinary tract infections include urethritis and cystitis. Pyelonephritis is divided into acute pyelonephritis and chronic pyelonephritis. It is more common in women.
The principles of treatment for urinary tract infection should first be clarified whether the condition is acute or chronic, whether it is an upper or lower urinary tract infection, what kind of pathogenic organisms are causing the infection and how sensitive they are to drugs, how much they affect kidney function, whether there is urinary system obstruction and vesicoureteral reflux and other triggers.
The following principles should be followed in the treatment.
1.Firstly, give sensitive antibiotics according to the common painful origin.
2. Perform urine culture before treatment, and then adjust the use according to the drug sensitivity results in time.
3, as far as possible, choose the antibiotics with high concentration in urine or target organs.
4.The course of treatment should be sufficient. The use of anti-inflammatory drugs should continue until 2 weeks after the symptoms disappear and the urine culture turns negative.
5.Avoid the abuse of antibiotics, especially avoid the use of nephrotoxic drugs.
6.Predisposing factors must be eliminated at the same time. If there are urinary tract abnormalities or functional abnormalities, they should be corrected or treated accordingly.
7.Strengthen the immune function of the body.
Receiving regular antimicrobial treatment mainly includes three aspects.
First, choose sensitive antibiotic treatment, and it is best to make bacterial culture first. When urinary discomfort, suspected of urinary tract infection attack, should first retain urine specimens (for bacterial culture) before taking drugs, such as taking drugs without permission and then retaining urine specimens, the bacteria are not easily inhibited growth, easy to cause “false negative”.
The second is that the treatment time should be sufficient. The general treatment time for urinary tract infections is 10-14 days. When the condition is recurrent, or when the condition is more serious, antibacterial treatment time should be extended appropriately. Generally, the drug is discontinued 5-7 days after the symptoms disappear, the white blood cells in the urine are normal, and the urine bacterial culture is negative. In a few cases, when 2-4 weeks of treatment is still not enough to relieve the symptoms, a long course of antibacterial therapy can be used.
Third, follow-up after discontinuation of the drug should be insisted. Patients are retested for urine leukocytes and urine bacterial culture at weeks 1, 2, 4 and 6 after discontinuation. If the results are negative several times, the disease can be considered cured. If there is a recurrence of urinary leukocytosis and a positive urinary bacterial culture, antibacterial therapy should be reintroduced. In case of recurrent attacks, a long course of antibacterial therapy may be used. The aim is not to kill the bacteria completely, but to inhibit their growth so that the number of bacteria in the urine is controlled at a low level without causing a recurrence.
Recurrence of urinary tract infection can be divided into recurrence and reinfection. It is generally accepted that recurrence of urinary tract infection is considered as recurrence of urinary tract infection if the infection occurs again within 2 weeks after the urinary tract infection is cured; on the contrary, if the infection occurs again after 2 weeks after the urinary tract infection is cured, it is diagnosed as reinfection regardless of whether the causative organism is the same as the previous one.
The following preventive measures can be taken for urinary tract infections.
1. General measures.
① Drink more water, preferably more than 2000ml daily intake, and urinate every 2 to 3 hours.
②Patients with sexual life related to timely urination after intercourse, if necessary, need to consult with an obstetrician and gynecologist and choose an appropriate form of contraception.
③Avoid the use of urinary tract devices as much as possible.
④cranberry juice, experimental research shows that cranberry juice can prevent Escherichia coli from adhering to the epithelial cells of the urinary tract, which can help prevent urinary tract infections.
2, antibiotic prevention: antibiotic prevention can significantly reduce the chance of recurrence of urinary tract infections in women. Antibiotic treatment is recommended for female patients with two or more recurrences of urinary tract infection within six months, or three or more recurrences within one year (Level A). Prevention regimens include continuous dosing regimens and post-coital dosing regimens for 6 to 12 months. These regimens must be used only after the original urinary tract infection has resolved (negative urine culture after 1 to 2 weeks of drug withdrawal), and antibiotics may be selected based on the results of previous drug sensitivity tests and the patient’s drug allergy history. Compared with the continuous drug delivery method, the post-coital dosing method is more convenient and easier to be accepted by patients related to sexual life, which can be taken within 2 hours after sexual intercourse with cephalexin or ciprofloxacin or furantoin
3.Prevention for menopausal female patients: topical application of estrogen ointment to the vagina can restore the local environment of the vagina and can reduce the chance of recurrence of urinary tract infection (Grade A).
4. Patients with frequent recurrence of urinary sensation should be examined in detail for anatomical abnormalities of their urinary system, underlying pathologies (such as stones, polycystic kidney, medullary spongy kidney, etc.) and overall immune system abnormalities.