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Long-Term Therapy for Chronic Bacteriuria in Men: U.S. Public Health Service Cooperative Study

RICHARD B. FREEMAN, M.D., F.A.C.P.; W. McFATE SMITH, M.D., M.P.H., F.A.C.P.; JAMES A. RICHARDSON, M.D., F.A.C.P.; PATRICK J. HENNELLY, M.D.; RICHARD H. THURM, M.D., F.A.C.P.; CHRISTFRIED URNER, M.D.; JOHN A. VAILLANCOURT, M.D.; ROBERT J. GRIEP, M.D., F.A.C.P.; and LOUIS BROMER
[+] Article and Author Information

▸Requests for reprints should be addressed to W. McFate Smith, M.D., U.S. Public Health Service Hospital, 15th Avenue and Lake Street, San Francisco, CA 94118; or Richard B. Freeman, M.D., The University of Rochester Medical Center, Rochester, NY 14642.

A document containing tabular data and an expanded description of the results of this study is available from Dr. Freeman at The University of Rochester Medical Center. A check or money order for U.S. $3.00 should accompany each request.


Rochester, New York


Ann Intern Med. 1975;83(2):133-147. doi:10.7326/0003-4819-83-2-133
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Response to therapy, renal function, and mortality were analyzed in a prospective study of 249 men with bacteriuria followed for up to 10 years. All patients received initial organism-specific antibiotic therapy followed by 2 years of continuous treatment with sulfamethizole, nitrofurantoin, methenamine mandelate, or placebo. Continuous therapy with active drugs delayed recurrence of bacteriuria and reduced acute clinical exacerbations of infection. Patients with pure Escherichia coli bacteriuria, normal intravenous pyelogram, no previous therapy, and a normal prostate had a good prognosis with short-term antibiotic therapy alone. The presence of prostatic or upper urinary tract calculi, pyelonephritic scars, or mixed or enterococcal infections predicted a poor bacteriologic prognosis. In the absence of severe urologic disease or concomitant noninfectious renal disease no patients with persistent bacteriuria developed renal failure. Continuous antibiotic therapy is of value in selected male patients with bacteriuria in reducing recurrence and acute clinical exacerbations of urinary tract infection.

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