Antibiotics For UTI Treatment - What Are My Options?
What is a UTI | Which antibiotic to use | Common side effects | Antibiotic resistance | New antibiotics | OTC antibiotics | Recurring UTIs | Treatment without antibiotics | Cranberry juice | More resources
What is a urinary tract infection (UTI)?
If you have ever experienced the frequent urge to go the bathroom with painful and burning urination, you have probably experienced a urinary tract infection (UTI). UTIs are one of the most common types of infections, accounting for over 10 million visits to health care providers each year. Roughly 40% of women experience a UTI at some time, and in women, it is the most common infection. Healthcare costs related to UTIs exceed $1.6 billion per year.
A urinary tract infection (UTI) can happen anywhere along your urinary tract, which includes the kidneys (the organ that filters the blood to make urine), the ureters (the tubes that take urine from each kidney to the bladder), the bladder (stores urine), or the urethra (the tube that empties urine from the bladder to the outside). Most UTIs occur in the bladder and urethra. Common symptoms include frequent need to urinate, burning while urinating, and pain in lower abdomen area.
There are different types of UTIs based on where the bacteria goes. A lower urinary tract infection occurs when bacteria gets into the urethra and is deposited up into the bladder -- this is called cystitis. Infections that get past the bladder and up into the kidneys are called pyelonephritis.
Urinary tract infection symptoms may include:
- Pain or burning upon urination
- A frequent or urgent need to urinate
- Passing small amounts of urine
- Blood in the urine or or pink-stained urine
- Urines that looks cloudy
- Strong-smelling urine
- Pain, cramping in the pelvis or pubic bone area, especially in women
Upper UTIs which include the kidney (pyelonephritis) may also present with symptoms of fever, chills, back or side (flank) pain, and nausea or vomiting.
Older patients may have an atypical presentation that includes altered mental status, lethargy, and weakness.
An infection of the tube that empties urine from the bladder to the outside is called urethritis, or an inflammation of the urethra. Urethritis symptoms can include burning with urination and a discharge. Urethritis is often caused by a sexually transmitted infection and may require a different antibiotic than those used to treat UTIs.
Most UTIs in women (roughly 85%) are caused by a bacteria known as Escherichia coli (E. coli). Other types of bacteria, such as Staphylococcus saprophyticus may infrequently be present.
UTI symptoms in women and men are similar. However, urinary tract infections occur more frequently in women than in men. This is because a woman’s urethra (the tube that empties urine from the bladder) is shorter and closer to the anus than in men, allowing easier entry of bacteria like E. coli into the urethra.
Menopause, lowered levels of estrogen, and elevated vaginal pH also increase the risk of a UTI. Women are also more likely to get an infection after sexual activity or when using a diaphragm and spermicide for birth control.
Other risk factors for the development of UTIs include catheter use, urinary tract structural abnormalities, diabetes, and a suppressed immune system.
Which antibiotic should be used to treat a UTI?
There are multiple types of antibiotics used to treat urinary tract infections (UTIs). Different treatments may be recommended in different areas of the country based on regional patterns of antibiotic resistance.
Most patients with an uncomplicated UTI will begin treatment without any special diagnostic test, although a urinalysis may be performed by taking a urine sample. In a urinalysis, the chemical components of the urine are determined, and the doctor may look at urine color, clarity, and a view a sample under the microscope. A urine culture may be order, too, but is not always needed to start treatment. A urine culture can define the specific bacteria causing the UTI in more complicated cases or in the case of treatment failure.
Symptoms like burning and stinging while urinating will usually clear up in within one day after starting treatment. Be sure to finish your entire course of medication. If symptoms are still present after 2 to 3 days, contact your healthcare provider.
More extensive diagnostic procedures or imaging tests like an X-ray may be required if you continue to have frequent UTIs.
What oral antibiotics are used to treat an uncomplicated UTI in women?
The following oral antibiotics are commonly used to treat most uncomplicated UTI infections (acute cystitis):
- nitrofurantoin (Furadantin, Macrobid, Macrodantin)
- fosfomycin (Monurol)
- sulfamethoxazole-trimethoprim (Bactrim DS, Septra DS, others)
Your doctor will choose your antibiotic based on your history, type of UTI, local resistance patterns, and cost considerations. First-line options are usually selected from nitrofurantoin, fosfomycin and sulfamethoxazole-trimethoprim. Amoxicillin/clavulanate (Augmentin) and certain cephalosporins, for example cefpodoxime, cefdinir, or cefaclor may be appropriate options when first-line options cannot be used.
Length of treatment for cystitis can range from a single, one-time dose, to a course of medication over 5 to 7 days. Kidney infections may require injectable treatment, hospitalization, as well as a longer course of antibiotic, depending upon severity of the infection.
Sometimes a UTI can be self-limiting in women, meaning that the body can fight the infection without antibiotics; however, most uncomplicated UTI cases can be treated quickly with a short course of oral antibiotics. Never use an antibiotic that has been prescribed for someone else.
In men with symptoms that do not suggest a complicated UTI, treatment can be the same as women. In men with complicated UTIs and/or symptoms of prostatitis are not present, men can be treated for 7 days with a fluoroquinolone (ciprofloxacin, levofloxacin). Tailor therapy once urine cultures are available.
Are quinolones safe?
The fluoroquinolones, such as ciprofloxacin (Cipro) and levofloxacin (Levaquin) have also been commonly used for simple UTIs; however, FDA safety recommendations strongly suggest that this class be reserved for more serious infections and only be used if other appropriate antibiotics are not an option.
- An FDA safety review found that both oral and injectable fluoroquinolones (also called "quinolones") are associated with serious and potentially disabling side effects involving tendons, muscles, joints, nerves and the central nervous system.
- These adverse effects can occur soon after administration to weeks after exposure, and may potentially be permanent.
- Patients should discuss the use of fluoroquinolones and their side effects with their healthcare provider.
However, certain oral fluoroquinolones may be appropriate for more complicated UTIs, including pyelonephritis and complicated UTIs in men with prostate involvement. For the outpatient treatment of uncomplicated pyelonephritis, the following quinolones may be appropriate. Based on resistance patterns (>10%), an inital dose of a long-acting parenteral antimicrobial, such as ceftriaxone, may be needed, or a 24-hour dose of an aminoglycoside.
Patients should be informed of the most current FDA warnings surrounding the use of fluoroquinolone antibiotics.
Will I need an intravenous (IV) antibiotic for a UTI?
If you are pregnant, have a high fever, or cannot keep food and fluids down, your doctor may admit you to the hospital so you can have treatment with intravenous (IV) antibiotics for a complicated UTI. You may return home and continue with oral antibiotics when your infection starts to improve.
In areas with fluoroquinolone resistance exceeding 10%, in patients with more severe pyelonephritis, those with a complicated UTI who have allergies to fluoroquinolones, or are unable to tolerate the drug class, intravenous therapy with an agent such as ceftriaxone, or an aminoglycoside, such as gentamicin or tobramycin, may be appropriate. Your ongoing treatment should be based on susceptibility data received from the laboratory.
Common side effects with antibiotic use
Each antibiotic is responsible for its own unique list of side effects, and the list is usually extensive. Be sure to discuss your individual antibiotic side effects with your healthcare provider. However, there are side effects that are common to most antibiotics, regardless of class or drug:
- Vaginal yeast infections or oral thrush (candida species): Antibiotics may also change the normal flora balance in the vagina and lead to a fungal overgrowth. Candida albicans is a common fungus normally present in small amounts in the vagina and does not usually cause disease or symptoms. However, vaginal candidiasis may occur when there is limited competition from bacteria due to antibiotic treatment.
- Abdominal (stomach) upset: Antibiotics are frequently linked with stomach upset such as nausea, vomiting, lack of appetite (anorexia), stomach pain, or heartburn (dyspepsia). Taking your antibiotic with a snack or a meal may help to decrease stomach upset, if you do not need to take it on an empty stomach. If your medication causes you to vomit, contact your doctor immediately for an alternative.
- Antibiotic-associated diarrhea: Antibiotics may commonly lead to uncomplicated antibiotic-associated diarrhea or loose stools, that will clear up after the antibiotic is stopped. Broad-spectrum antibiotics can also kill the normal gut flora (“good bacteria) and lead to an overgrowth of infectious bacteria, such as Clostridium difficile (C. difficile). If the diarrhea is severe, bloody, or is accompanied by stomach cramps or vomiting, a physician should be contacted to rule out C. difficile. The most common antibiotics implicated in antibiotic-associated diarrhea are amoxicillin-clavulanate, ampicillin, cephalosporins, fluoroquinolones, azithromycin, and clarithromycin.
- Stevens Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN): Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but serious allergic drug reactions. Skin reactions like rash, skin peeling, and mucous membranes sores can occur and may be life-threatening. Antibiotics such as sulfonamides, penicillins, cephalosporins, and fluoroquinolones may result in SJS and TEN.
What about antibiotic resistance?
Resistance rates for antibiotics are always variable based on local patterns in the community and specific risk factors for patients, such as recent antibiotic use, hospital stay or travel. If you have taken an antibiotic in the last 3 months or traveled internationally, be sure to tell your doctor.
High rates of antibiotic resistance are being seen with both ampicillin and amoxicillin for cystitis (E. coli), although amoxicillin/clavulanate (Augmentin) may still be an option. Other oral treatments with reported increasing rates of resistance include sulfamethoxazole and trimethoprim (Bactrim DS, Septra DS) and the fluoroquinolones. Resistance rates for the oral cephalosporins and amoxicillin/clavulanate are still usually less than 10 percent.
Always finish taking your entire course of antibiotic unless your doctor tells you to stop. Keep taking your antibiotic even if you feel better and you think you don't need your antibiotic anymore.
If you stop your treatment early, your infection may return quickly and you can develop resistance to the antibiotic you were using previously. Your antibiotic may not work as well the next time you use it.
Latest antibiotics for UTIs
The latest FDA antibiotic approvals for UTIs include:
- Vabomere (meropenem and vaborbactam) is a combination carbapenem antibiotic and beta-lactamase inhibitor. Vabomere was first approved in August of 2017.
- Vabomere is used for the treatment of adult patients with complicated urinary tract infections (including pyelonephritis) due to susceptible Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae species complex.
- Vabomere is given as an intravenous infusion every 8 hours. Dosage adjustments are required in patients with varying degrees of kidney impairment.
- Zemdri (plazomicin) is an aminoglycoside antibacterial for the treatment of complicated urinary tract infections, including pyelonephritis. Zemdri was first approved in February of 2015.
- Zemdri is used against certain Enterobacteriaceae in patients who have limited or no alternative treatment options. Zemdri is an intravenous infusion, administered once daily.
- Avycaz (ceftazidime and avibactam) is a cephalosporin and beta-lactamase inhibitor antibiotic combination used for complicated UTIs, including pyelonephritis, in adult and pediatric patients 3 months and older, and without alternative treatment options. Avycaz was first approved in February of 2015.
- Avycaz is used for complicated UTIs caused by the following susceptible Gram-negative microorganisms: Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Citrobacter freundiicomplex, Proteus mirabilis, and Pseudomonas aeruginosa.
- Avycaz is given as an intravenous infusion every 8 hours. Dosage adjustments are required in patients with varying degrees of kidney impairment.
- Zerbaxa (ceftolozane and tazobactam) is a cephalosporin and beta-lactamase inhibitor combination for the treatment of complicated urinary tract infections including pyelonephritis. Zerbaxa was first approved in December 2014.
- Zerbaxa is given as an intravenous infusion every 8 hours. Dosage adjustments are required in patients with varying degrees of kidney impairment.
See also: Treatment Options for UTIs
Are there any over-the-counter antibiotics for UTIs?
Over-the-counter (OTC) antibiotics for a UTI are not available. You should see your doctor to have your symptoms evaluated.
Your provider may recommend an OTC product called Uristat (phenazopyridine) to numb your bladder and urethra to ease the burning pain during urination. Uristat can be bought without a prescription at the pharmacy. A similar phenazopyridine product called Pyridium is also available.
Take phenazopyridine for only 48 hours, and be aware it may cause your urine to turn a brown, orange or red color which may stain fabrics or contact lenses. It may be best to not wear contact lenses while being treated with phenazopyridine.
Phenazopyridine is not an antibiotic and will not cure a UTI.
See also: Ratings of Urinary Anti-Infectives
What if I have frequent, recurring UTIs?
Within a year of havig a UTI infection, roughy one-quarter to one-half of women will have another UTI. For these women antibiotic prophylaxis (medication to help prevent a UTI) may be recommended by her health care provider. With a recurrent course of UTIs, a urine culture or imaging tests may be required for further analysis.
For recurrent UTIs, there are several antibiotic options for prevention:
- A shorter course (3 days) of antibiotics at the first sign of UTI symptoms; a prescription may be given to you to keep at home.
- A longer course of low-dose antibiotic therapy.
- Take a single dose of an antibiotic after sexual intercourse.
The choice of antibiotic is based on previous UTIs, effectiveness, and patient-specific factors such as allergies and cost. Antibiotics commonly used for recurrent UTIs can include sulfamethoxazole-trimethoprim, nitrofurantoin, cefaclor, or cephalexin.
In postmenopausal women with vaginal dryness that may be leading to recurrent UTIs, vaginal estrogen may be an effective treatment. Treatment options your doctor might recommend include: Estring(a vaginal ring), Vagifem (vaginal tablet insert), or vaginal estrogen creams (examples: Premarin, Vagifem, Yuvafem).
Can I treat a UTI without antibiotics?
UTI treatment without antibiotics is NOT usually recommended. An early UTI, such as a bladder infection (cystitis), can worsen over time, leading to a more severe kidney infection (pyelonephritis). However, a small study has suggested early, mild UTIs might clear up on their own. It's always best to check with your doctor if you are having UTI symptoms.
Pregnant women should always see a doctor as soon as possible if they suspect they might have a UTI, as this can lead to a greater risk of delivering a low birth weight or premature infant.
Does cranberry juice prevent a UTI?
Some patients may want to use cranberry or cranberry juice as a home remedy to treat a UTI. Cranberry juice has not been shown to cure an ongoing bacterial infection in the bladder or kidney.
Cranberry has been studied as a preventive maintenance agent for UTIs. Studies are mixed on whether cranberry can really prevent a UTI. Cranberry may work by preventing bacteria from sticking to the inside of the bladder; however, it would take a large amount of cranberry juice to prevent bacterial adhesion. More recent research suggests cranberries may have no effect on preventing a UTI
- According to one expert, the active ingredient in cranberries -- A-type proanthocyanidins (PACs) -- are effective against UTI-causing bacteria, but is only in highly concentrated cranberry capsules, not in cranberry juice.
- However, cranberry was not proven to prevent recurrent UTIs in several well-controlled studies, as seen in a 2012 meta-analysis of 24 trials published by the Cochrane group.
- While studies are not conclusive, there is no harm in drinking cranberry juice. However, if you develop symptoms, see your doctor. Some people find large quantities of cranberry juice upsetting to the stomach.
The effectiveness of many herbal or home remedies may not have been scientifically tested to the same degree as prescription medications -- or at all. Over-the-counter herbal products and dietary supplements are not regulated by the FDA. Side effects and drug interactions may still occur with alternative treatments. Always check with your health care professional before using an over-the-counter, herbal or dietary supplement for any condition. In most cases, an antibiotic is the best treatment for a UTI.
Increasing fluid intake like water, avoiding use of spermicides, and urinating after intercourse may be helpful in preventing UTIs, although limited data is available.
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- Kidney Infections
- Urinary Tract Infection In Children
- Urinary Tract Infection In Men
- Urinary Tract Infection In Women
- Alcohol and Antibiotic Interactions
- Antibiotic Resistance: The Top 10 List
- Antibiotic Shortages: A Serious Safety Concern
- Antibiotics - Common Side Effects, Allergies and Reactions
- Antibiotics and Birth Control Pill Interactions
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- Why Don’t Antibiotics Kill Viruses?
- Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2012;10:CD001321. Accessed June 3, 2019 at https://www.ncbi.nlm.nih.gov/pubmed/23076891
- Lala V, Minter DA. Acute Cystitis. [Updated 2019 Mar 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459322/
- Hooton T, et al. Patient education: Urinary tract infections in adolescents and adults (Beyond the Basics). Oct 11, 2018. Accessed June 3, 2019 at https://www.uptodate.com/contents/urinary-tract-infections-in-adolescents-and-adults-beyond-the-basics
- Avycaz Product Label. Allergan. Accessed May 30, 2019 at https://www.allergan.com/assets/pdf/avycaz_pi
- Acute complicated urinary tract infection (including pyelonephritis) in adults. Up to Date. April 1, 2019. Accessed June 3, 2019 at https://www.uptodate.com/contents/acute-complicated-urinary-tract-infection-including-pyelonephritis-in-adults
- FDA Drug Safety Communication: FDA advises restricting fluoroquinolone antibiotic use for certain uncomplicated infections; warns about disabling side effects that can occur together. May 12, 2016. Accessed on June 4, 2019 at http://www.fda.gov/Drugs/DrugSafety/ucm500143.htm
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