50 Years of Urinary Tract Infections and Treatments

Has Much Changed?

Brandon Lajiness; Michelle J. Lajiness


Urol Nurs. 2019;39(5):235-239. 

In This Article

Abstract and Introduction


Urinary tract infections (UTIs) have burdened mankind long before a causative agent was even found, dating all the way back to ancient Egypt. Up until the past 80 years, there was no extremely effective treatment of UTI. However, that all changed with the emergence of antibiotics. Once nitrofurantoin was introduced and its efficacy was noted for UTI, it became and remained the drug of choice for first-line therapy. Antimicrobial stewardship is one significant change in the last 50 years that has limited the use of antibiotics to "only when necessary" and with the right medication to prevent development of resistance. The diagnosis of UTI has improved; more tests (e.g., urinalysis, urine cultures) have been developed than just the color/cloudiness test. The treatment of complicated and recurrent UTI has also made considerable progress in the last 50 years, along with principles of prevention.


A urinary tract infection (UTI) is an infection of the lower and/or upper genitourinary tact. A UTI is diagnosed based on the presence of a pathogen in the urinary tract and with an associated group of symptoms. Dysuria is the key symptom of bacterial cystitis. Frequency, urgency, hematuria, and supra pubic pain are variably present and can be associated with other diagnoses (Brubaker, Carberry, Nardos, Carter-Brooks, & Lowder, 2018). UTIs are further categorized as uncomplicated, complicated, recurrent, and catheter-associated (see Table 1) (Bartoletti, Cai, Wagenlehmer, Naber, & Johansen, 2016).

UTIs have been a burden for mankind long before bacteria were recognized as the causative agent. One of the oldest written medical records, dating back to ancient Egypt, was the Ebers papyrus, which contained treatment for urine retention and excessive urination (Nickel, 2005). Throughout history, there are detailed descriptions and classifications of urinary symptoms that document treatments that range from conservative (herbs, bed rest) to invasive procedures, including surgery for stones, abscesses, and retention (Nickel, 2005).

A UTI is one of the most common infectious diseases, especially in women. It is estimated that UTIs affect greater than 30% of the population worldwide (Bartoletti et al., 2016). In the United States, there are more than 8 million ambulatory visits annually for UTI; 21% are emergency room visits, and 84% of those are women (Brubaker et al., 2018).

The majority of community-acquired UTIs are caused by the organism Escherichia coli (E. coli). Other organisms include Klebsiella pneuemoniae, Proteus mirabili, and E. faecalis.