What other medications can I use?
6th year pharmacy student here.
When treating UTI's, we try to start with a "shotgun" approach. In other words, we want to try to use an antibiotic that will kill as many bacterial organisms as possible, even if it's "weaker" than other antibiotics. Once we know what bacteria is causing the UTI, then we go with a "sniper" approach, which is basically picking an antibiotic that is useless against most bacteria, but SUPER good at killing one particular type of bacteria.
With many of the "shotgun" antibiotics, bacteria are rapidly becoming resistant to their effects. While Bactrim DS (trimethoprim/sulfamethoxazole) and Macrobid (nitrofurantoin) are the perfect "first-line" or "shotgun" antibiotics for UTI's, they sometimes don't work like we hope. We also usually try one of the "fluoroquinolone" antibiotics like Cipro (ciprofloxacin) or Levaquin (levofloxacin).
There are several factors that come into play when picking an antibiotic, one of which is whether it will kill the bacteria, but another is whether it is safe for the person taking it. Antibiotics are very common and usually well-tolerated without many side effects, but some of them can be very dangerous in certain patients, or simply won't work at all.
There are also several reasons why your antibiotics might not have worked so far:
- It could be a resistant bacteria
- It might not be bacterial at all, as it could be viral or fungal or some other problem that is less common or harder to diagnose
- Foods you eat, medications you take, and/or other diseases/problems you have might affect how well the antibiotic works
The other options for treating a resistant UTI, though, are usually reserved for very specific cases, and usually require the person taking them to either have a urine culture (pee in cup and try to grow bacteria from it so we can see what is causing the problem) first, or routine/scheduled monitoring. Some of these options are:
- Is given IV only, so would probably require hospital admission
- VERY good at killing bacteria
- Also only given IV
- Also VERY good at killing bacteria
Depending on what bacteria is causing your symptoms, vancomycin or ceftazidime/avibactam might be options for treatment. Both of these antibiotics are "sniper" medications (sort of), but they require more testing before they can be prescribed because they only treat certain bacterial infections and may have more side effects than other antibiotics.
There's a lot of options, really, but most of them depend on very specific testing and patient-specific details, so they would all require a more thorough examination first.
Long story short:
- Be patient... It can take several days (as many as a few weeks in some treatment-resistant cases) for symptoms to completely resolve
- Let your doctor and/or pharmacist know that your medication is not working so they can narrow down the options
- Consider asking your doctor if your UTI could be non-bacterial (like a fungal or viral infection instead), as this would require a completely different set of medications (anti-fungals or anti-virals instead of antibiotics)
- If you REALLY want your symptoms gone, be prepared for a lot of lab work (perhaps hospital admission, at least a few urine samples, maybe blood testing with some antibiotics, etc.), as this would get to a very specific diagnosis really fast and help narrow the treatment options from hundreds to just a handful
Bactrim (or Septra) and Macrobid are perfect first options, so there's no reason to doubt them until they've failed for several days or your symptoms keep getting worse. Ciprofloxacin, levofloxacin, imipenem, meropenem, vancomycin, and ceftazidime/avibactam, and the aminoglycosides (gentamicin, tobramycin, and amikacin) would be my next considerations from a pharmacy point of view. Maybe ask your doctor about ciprofloxacin, gentamicin, meropenem, or vancomycin. They tend to be the more common ones out of that list.
I hope this helps! I know it was a lot of information...
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