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How to treat an Embedded UTI

When should a patient be treated?

Patients should be treated when they present with chronic bladder pain, chronic pelvic pain,
recurrent urinary infection, voiding problems and overactive bladder symptoms. These
complaints overlap considerably and usually there is shared aetiology.

Image by Roberto Sorin

The only scientifically proven way to treat a Chronic Urinary Tract Infection

Antibiotics are used to treat these infections. In order to achieve sufficient levels of antibiotics in the affected tissues we have to use the highest, tolerated doses in the permitted ranges.
Low-dose, once-daily regimes are not reliable. Chronic ingrained infections require long treatment courses. The infections are commonly mixed and one antibiotic may be insufficient. Nowadays to overcome this problem the disinfectant, methenamine (Hiprex), is used.
However, a second antibiotic may be necessary but it will be used only if it is endorsed by an improved response which reverses when this is withheld.  The outcome measures used to check progress are symptoms, change in urinary white blood cell counts, and changes in urinary urothelial cell count.

If the treatment is effective there will be symptom improvement and the urinary white blood cell and urothelial cell counts will start to fall, although they oscillate on the way down. Eventually the urine clears, but this does not mean that the infection has been eradicated. Infection and inflammation of the bladder can persist for many weeks without urine signals.

Urinary antibiotics will kill bacteria that break out of the cells and prevent them from infecting new cells. A full dose, preferably spread over the day, to keep levels up over 24- hours, is superior to once-daily regimes which allow the disease to escape during the antibiotic trough. It seems, from dose titration studies, that the antibiotics do penetrate the tissues and influence some of the infection.

There is much data from longitudinal treatment studies. These show that the cell-associated infection of the bladder wall subsides gradually. This is associated with slow clearance of the urinary white blood cells, but the symptom clearance lags significantly behind the urine. Cessation studies have illustrated not to attempt stopping antibiotics until the urine is clear and all symptoms have gone. Despite that caution, some patients relapse rapidly and require longer treatments. 

Contrary to popular expectation, the treatment experiences few problems with antibiotic resistance. There are Darwinian reasons for this because bacterial resistance results from evolution. The bacteria divide very slowly so that replication and variation are minimal. The antibiotic doses provide a lethal selection pressure that favours extinction, as opposed to evolution. For resistance to evolve, the correct balance of variation, replication and selection must exist. The approach is designed to subvert those elements.


The antibiotics do not affect a person’s immunity.

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