The urinary tract
antiseptics discussed herein have specific advantages and disadvantages. All share a pharmacokinetic fate that makes them effective in treating acute, uncomplicated symptomatic bladder
bacteriuria.
Nitrofurantoin appears to be the most versatile because it is effective against upper tract
infection, recurrent bacteriuria, and as a long-term suppressive agent in children and pregnant patients with only a low incidence of the development of resistance.
Methenamine, when used with proper understanding of it pharmacokinetic behavior, is also effective in females with uncomplicated recurrent
bacteriuria including those with multiply resistant pathogens, as well as a prophylactic agent in males with
recurrent infection. There is little evidence that
methenamine combined with mandelic or
hippuric acid confers any pharmacologic or therapeutic advantage over the use of
methanamine base alone.
Nalidixic acid and
oxolinic acid, in addition to effectiveness in treating uncomplicated acute lower
urinary tract infections, may be effective in some patients with
recurrent infections, but requires careful sensitivity monitoring of pathogens for the development of resistance. Finally, in a society whose economic pressures are such that it may not be cost-effective to use
sulfamethoxazole-
trimethoprim for urinary tract prophylaxis--unless two or more acute
infections occur per year--the use of these
urinary antiseptics may offer increasing advantages now and in the future.