Preface.
Although the clinical presentation and the treatment of lower urinary tract infection (UTI) have changed little in the 60 to 70 years of the 'antibiotic era', uropathogenic bacteria have not been slow to respond to the selecting pressure of antimicrobials. This is because such infections are common. Approximately 3% of all consultations made to general practitioners are for symptoms of UTI and approximately 12-20% of all antibiotic prescriptions are for this indication. Between one-quarter and one-half of all women experience a UTI at some time. The problem, therefore, is a considerable one and warrants reevaluation. This supplement is based upon papers presented at a meeting held in March 2000 in Vienna, Austria and sponsored by Leo Pharmaceutical Laboratories. It draws together the current views on the diagnosis and the treatment of UTIs at a time when the disease-causing microorganisms are most certainly changing. Antibiotic resistance to commonly used agents, such as trimethoprim and ampicillin, often now exceeds 30-50%. The clinician may be tempted to choose an agent such as a fluoroquinolone for the treatment of this disease, yet it is known that fluoroquinolone resistance can develop rapidly. Views on the length of treatment have also changed over the years and a 3 day regimen is usually now advocated. Pivmecillinam, which is hydrolysed to mecillinam after absorption, has a novel mode of action, rapid bacterial cell penetration and lower affinity for common beta-lactamases. Its spectrum of activity and good safety profile make it an ideal candidate for the treatment of this common condition. Experience in several countries over many years confirms this assessment and it may be time to reconsider the potential role of pivmecillinam in the treatment of UTIs. The Editors would like to thank Inge Boe and Paul Menday of Leo Laboratories for their untiring support and assistance in the preparation of this supplement.
Nicolle
LE
Vienna, Austria, March 2000.
Wise
R
Wood
MJ