Urinary Tract Infection In Renal Insufficiency: "The Step Child"

Abstract

To the Editor:— The significance of ascending urinary tract infection as a cause of pyelonephritis is well recognized, thus prevention by correcting possible urinary tract abnormalities becomes of paramount importance. Apart from surgical correction of anatomical and functional abnormalities, which often is fundamental toward successful eradication of infection, the proper selection and application of antibacterial therapy can be a challenge. This is particularly true if severe chronic renal disease already is present. If bacterial cultures of urine from such patients indicate sensitivity of the offending organism to the more commonly used antibacterial agents such as sulfonamides, nitrofurantoin, and nalidixic acid for long term administration, standard therapeutic dosages often give disappointing results. Only too often the uremic patient with bacteriuria remains infected and the infecting organism becomes resistant to the drug administered. It is further a dilemma for the treating physician that dose recommendation of drugs for treatment of bacteriuria are