Antibiotics For UTI Treatment - What Are My Options?
Medically reviewed on Sep 20, 2016 by L. Anderson, PharmD.
Have you experienced a urinary tract infection?
If you have ever experienced the frequent urge to go the bathroom with painful burning urination, you have probably experienced a urinary tract infection (UTI). You may be surprised to know that UTIs are the second most common type of infection in the body, accounting for over 8 million visits to health care providers each year. Sometimes a UTI can be self-limiting, meaning that your body can fight the infection without antibiotics; however, most uncomplicated UTI cases can be treated quickly with a short course of oral UTI antibiotics.
What is a urinary tract infection (UTI)?
A UTI infection 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).
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 . An infection of the tube that empties urine from the bladder to the outside is called urethritis. UTI symptoms in women and men are similar.
Urinary tract infection symptoms may include:
- Pain or burning upon urination
- A frequent or urgent need to urinate
- Blood in the urine or a cloudy or pink-stained urine
- Pain, cramping in the lower stomach
Upper UTIs which include the kidney may also have symptoms of fever, back pain, and nausea or vomiting.
Urinary tract infections occur more frequently in women than in men because a woman’s urethra is shorter and closer to the anus than in men, allowing easier entry of bacteria into the urethra. Women are also more likely to get an infection after sexual activity or when using a diaphragm for birth control. Menopause also increases the risk of a UTI.
Which antibiotic should be used to treat a UTI?
There are multiple types of antibiotics used to treat urinary tract infections (UTIs). Most UTIs (75-95%) in women are caused by a bacteria known as Escherichia coli (E. coli). Other Enterobacteriaceae types of bacteria may infrequently be present. Different treatments may be recommended in different areas of the country based on regional patterns of drug resistance, so it’s important to consider these effects, even with E. Coli.
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, 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 while urinating will usually clear up in within one to two days 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
What oral antibiotics are used to treat an uncomplicated UTI?
The following oral antibiotics are commonly used to treat most UTI infections (acute cystitis):
- Sulfamethoxazole-trimethoprim (Bactrim DS, Septra DS, others)
- Nitrofurantoin (Macrobid, Macrodantin)
- Fosfomycin (Monurol)
- Amoxicillin/clavulanate (Augmentin)
- Certain cephalosporins like cefpodoxime, cefdinir, or cefaclor
The fluoroquinolones, such as ciprofloxacin (Cipro) and levofloxacin (Levaquin) have also been commonly used for uncomplicated cystitis; however, July 2016 FDA recommendations strongly suggest that the fluoroquinolone 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 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 with their healthcare provider.
However, the oral fluoroquinolones are appropriate for more complicated UTIs, including pyelonephritis. For the outpatient treatment of uncomplicated pyelonephritis, the following quinolones are typically be used:
Are intravenous (IV) antibiotics used for a complicated 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 UTI. You may return home and continue with oral antibiotics when your infection starts to improve.
In areas with fluoroquinolone resistance exceeding 10 percent, 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 with food or a meal may help to decrease stomach upset, but check with your pharmacist.
- 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, and 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 or travel.
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-trimethoprim (Bactrim DS, Septra DS) and the fluoroquinolones. Resistance rates for the oral cephalosporins and amoxicillin/clavulanate are still usually less than 10 percent.
What new antibiotics are available for UTIs?
The latest FDA antibiotic approvals for UTIs include:
- Avycaz (avibactam and ceftazidime) is a next generation, non-β lactam β-lactamase inhibitor and third-generation, antipseudomonal cephalosporin antibiotic combination for the treatment of complicated intra-abdominal infections in combination with metronidazole and complicated urinary tract infections (UTIs), including pyelonephritis, in those who have limited or no alternative treatment options.
- Avycaz was first approved on February 25th, 2015 and is manufactured by Allergan Inc. 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 intra-abdominal infections and used with metronidazole. Zerbaxa is also used for complicated urinary tract infections (cUTI), including pyelonephritis.
- Zerbaxa was first approved on December 19th, 2014 and is manufactured by Merck and Co. Zerbaxa is given as an intravenous infusion every 8 hours. Dosage adjustments are required in patients with varying degrees of kidney impairment.
See also: More treatment options....
Are there any over-the-counter antibiotics for UTIs?
Over-the-counter antibiotics for a UTI are not available. 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 with a prescription from your doctor. 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.
See also: Ratings of Urinary Anti-Infectives
What if I have frequent, recurring UTIs?
Some women may have 2 or 3 UTIs in a year; for these women antibiotic prophylaxis may be recommended by her health care provider. For recurrent UTIs, there are several options:
- 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 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, cephalexin, or norfloxacin.
In postmenopausal women with vaginal dryness that may be leading to recurrent UTIs, vaginal estrogen may be an effective treatment.
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. According to one expert, the active ingredient in cranberries -- A-type proanthocyanidins (PACs) -- is effective against UTI-causing bacteria, but is only in highly concentrated cranberry capsules, not in cranberry juice. Cranberry seems to 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. In addition, cranberry was not proven to prevent recurrent UTIs in well-controlled studies, as seen in a 2012 meta-analysis of 24 studies published by the Cochrane database. Previous studies suggested cranberry or cranberry juice might have been useful to prevent UTIs.
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 alternative treatment, herbal or dietary supplement for any condition. In most cases, an antibiotic is the best treatment for a UTI.
More Topics under Urinary Tract Infection:
Micromedex® Care Notes:
- Acute Bronchitis in Adults
- Alcohol and Antibiotics
- Antibiotic Resistance
- Antibiotic Shortages: A Serious Safety Concern
- Antibiotics - Common Side Effects, Allergies and Reactions
- Antibiotics and Birth Control Pill Interactions
- Top 10 FAQs for Middle Ear Infections in Children
- 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.
- Hooton T, et al. Acute uncomplicated cystitis and pyelonephritis in women. Up To Date. May 26, 2016. Accessed September 19, 2016.
- Hooton T, et al. Patient education: Urinary tract infections in adolescents and adults (Beyond the Basics). May 29, 2015. Accessed September 19, 2016 at https://www.uptodate.com/contents/urinary-tract-infections-in-adolescents-and-adults-beyond-the-basics
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