Management of urinary tract infection in general practice

In a general practice an attempt was made to determine the relative merits of cycloserine, sulphadimidine or nitrofurantoin in the treatment of urinary tract infection. Bacteriological follow-up continued for 2 years. The incidence of patients with symptoms and with significant bacteriuria before treatment was 13 per 1,000 females at risk.

With a follow-up of 50 days nitrofurantoin and cycloserine had an apparent cure rate of 78 and 79 per cent respectively. Sulphadimidine had a cure rate of only 43 per cent due largely to a higher incidence of organisms resistant in vitro. Results after 2 years show that apparent cures are much fewer (nitrofurantoin 46%, cycloserine 36%, sulphadimidine 29%) and there is much less difference in the effectiveness of the various drugs. Only 4 patients stopped treatment because of drug toxicity.

The results of intravenous pyelography in 155 patients suggest that rather than X-ray all patients with urinary-tract symptoms, prolonged bacteriological follow-up will reveal those in whom X-rays may be helpful.