Chronic UTI: Doing the right thing

My late friend, mentor and former UCL professor of medicine James Malone-Lee advised that a good clinician does the right things very well for patients, but a medical academic is charged to determine, through research, what the right things are to do. We both sought to determine the “right way” to treat bladder infections because he, as a geriatrician, and I, as a neurorehabilitation doctor treating people with CNS diseases such as #MS, saw so many routinely.

James believed standard treatment courses were predominantly effective palliatives and chose to fight battles against bladder #infection chronicity by using #antibiotics until he was highly confident the infecting pathogens were annihilated to effect cure, which typically took several months. In doing so, he also battled against conventional thinking but had many immensely grateful patients. However, oral antibiotics progressively are becoming less effective, interfere with the gut microbiome and risk AMR.

I chose to consider delivering the antimicrobial armaments to the battlefield directly rather than sending them through the system only to leave it to act in the urinary cavity. The superiority of direct drug targeting is a fundamental tenet of therapeutics. Principles matter. What you see is not all there is.

Direct targeting is used routinely for bladder cancer treatments. #Urologists today use #intravesical aminoglycosides to treat people with chronic and recurrent UTI but do so off-label, using risky Heath-Robinson approaches for which personal responsibility must be taken for any complications. Clinicians need support to do the right things very well. I hope that when UroPharma’s direct-to-bladder drug-delivery technology is approved, we clinicians, finally, will be able to do the right things very well for cystitis patients with the regulators’ blessings.