The recent article by Brubaker and Wolfe describes recent microbiological findings on urine and the bladder. They suggest these add weight to the ideas put forward by Maskell 15 years ago that “unconventional” or “fastidious” organisms–chiefly lactobacilli and diphtheroids–may cause symptoms of typical urinary infection, such as dysuria and frequency.

I wish to draw attention to work undertaken specifically to challenge the theory of Maskell at the time she proposed it, which has not been taken into consideration either by her or by Brubaker and Wolfe.

In a formal debate, initiated by my colleagues and attended by Dr Maskell, we presented detailed arguments opposing the role of such bacteria in urinary infections. We are not aware that our conclusions were refuted.

We later conducted a clinical trial in general practice that showed that antibiotic treatment with a compound active against lactobacilli and diphtheroids (amoxicillin/clavulanate) gave the same “cure rate” in patients with symptoms but no significant bacteriuria as did treatment with a compound inactive against both (fosfomycin).

I believe that it is important that both sides of this case should be presented. If lactobacilli and diphtheroids are regarded as urinary pathogens when they in fact are not, this will result in overuse of antibiotics.