- Treatment for Urinary Tract Infections
- Antibiotics Use for Uncomplicated UTIs
- Antibiotics Use for Complicated UTIs
- Antibiotic Warnings and Treatment Concerns
- Other Medication Used for Treating UTIs
- Treatment Strategies for Recurrent UTIs
- UTIs Caused by ESBL-Producing Bacteria: What to Know
- When to Contact Your Physician About Symptoms
- Taking Cranberry Juice for UTIs
- Urinary tract infection in women – self-care
- Diagnosis and Management of Uncomplicated Urinary Tract Infections
- UTI Antibiotics: Treatment For Urinary Tract Infection
- UTI Treatment Antibiotics Overview
- How UTI Antibiotics Are Selected
- UTI Antibiotics Effectiveness
- First Line UTI Antibiotics: A Best Guess Treatment
- Can I Change UTI Antibiotics?
- Adverse Effects Of UTI Antibiotics And Specific Patient Factors
- Are Fluoroquinolones Safe For Urinary Tract Infection?
- UTI Antibiotics Resistance Rates
- UTI Antibiotics Cost And Availability
- Why Aren’t My UTI Antibiotics Working?
- My UTI Test Results Are Negative, What Now?
- Do I Have Recurrent UTI Or Interstitial Cystitis?
- Can You Break The UTI Antibiotic Treatment Cycle?
- Which Antibiotic Will Work Best?
Treatment for Urinary Tract Infections
Oral antibiotics are a go-to treatment for urinary tract infections. Thinkstock
If you’ve been treated for a UTI in the past, your doctor may recommend a different antibiotic the next time you get an infection. (1) This is because some types of bacteria that cause UTIs have become resistant to certain antibiotics. Bacteria are less likely to be resistant to newer antibiotics.
Antibiotics Use for Uncomplicated UTIs
Antibiotics are considered the first-line of treatment for urinary tract infections. Most urinary tract infections are dubbed simple or uncomplicated UTIs. The particulars regarding which antibiotics are prescribed — and for how long — depend on the type of bacteria detected in your urine and your current health. Typically, if you are diagnosed with an uncomplicated UTI, one of the following will be prescribed:
- Trimethoprim and sulfamethoxazole (Bactrim, Septra)
- Fosfomycin (Monurol)
- Nitrofurantoin (Macrodantin, Macrobid)
- Cephalexin (Keflex)
- Ceftriaxone (2)
The above antibiotics are all similar in efficacy. But it’s important to note that the commonly prescribed antibiotic amoxicillin and clavulanate (Augmentin) has been shown to be significantly less effective than others when it comes to combating urinary tract infections. (3)
In most cases, either a three-day or five-day course of antibiotics is prescribed to treat an uncomplicated UTI. Usually pain and the frequent urge to urinate subsides after a few doses. Regardless of the medication prescribed or how quickly you feel relief, it’s always important to complete the entire course of antibiotics as directed by your healthcare provider. If UTIs are not fully treated, they can more easily return. (4)
Antibiotics Use for Complicated UTIs
A UTI is considered complicated if:
- Urinary tract abnormalities are present
- You’re pregnant
- The patient is a child
- A comorbidity is present that increases risk of infection or treatment resistance, such as poorly controlled diabetes
In addition, most UTIs in men and the elderly are considered complicated, and kidney infections are often treated as a complicated UTI as well. (5)
If a UTI is a considered complicated, then a 10- to 14-day course of antibiotics may be required. Also, the initial dose of antibiotics may be started intravenously (IV) in the hospital. After that, antibiotics are given orally at home. In addition, follow-up urine cultures are generally recommended within 10 to 14 days after treatment.
Antibiotic Warnings and Treatment Concerns
The most commonly prescribed antibiotics for uncomplicated UTIs are similar in efficacy. But it’s important to note that ampicillin, amoxicillin, and sulfonamides are no longer the drugs of choice for combatting UTIs because of the emergence of antibiotic resistance. In addition, amoxicillin and clavulanate (Augmentin) has been shown to be significantly less effective than others when it comes to treating urinary tract infections. (6)
Also, the Food and Drug Administration (FDA) advises against using the group of antibiotic medication known as fluoroquinolones — such as ciprofloxacin (Cipro), levofloxacin (Levaquin), and others — for uncomplicated UTIs. These medicines should only be considered if no other treatment options are available. In some cases, such as a complicated UTI or kidney infection, a healthcare provider may decide that a fluoroquinolone medicine is the best option. (7)
For pregnant women, some common antibiotics, such as fluoroquinolones and tetracyclines, should not be prescribed because of possible toxic effects on the fetus. But oral nitrofurantoin and cephalexin are considered good antibiotic choices for pregnant women with asymptomatic bacteriuria and acute cystitis. (8)
While most UTIs can be effectively treated with antibiotics, bacteria are becoming more and more resistant to antibiotics. Each time you take an antibiotic, the bacteria that normally resides in your system are more likely to become resistant to antibiotics. Because of this, prevention is a very important factor in treating UTIs. (9)
Other Medication Used for Treating UTIs
In addition to antibiotics, your doctor may recommend phenazopyridine (Pyridium). This is an over-the-counter medication used to numb the lining of the urinary tract to make urination more comfortable while you wait for the antibiotics to work. Still, be aware that the medicine will make your urine turn bright orange.
Treatment Strategies for Recurrent UTIs
Recurrent urinary tract infections, defined as three or more UTIs within 12 months, or two or more occurrences within six months, is very common among women. Normally, treatment of an initial recurrence of a urinary tract infection is the same as for other cases of uncomplicated UTIs: three to five days of antibiotics. Managing risk factors — for example, by maintaining good hygiene practices, such as wiping from front to back, avoiding spermicides, and urinating before and after intercourse — can lower your risk of having another UTI.
In addition, for certain cases of chronic urinary tract infection recurrences, a physician may recommend antimicrobial prophylaxis, which is the use of antibiotics to prevent another infection. This practice has been shown to be effective in reducing the risk of recurrent UTIs in women with two infections during the previous year. (As of right now, there are no guidelines to recommend the use of any specific antibiotic, dosage, or duration.) For those whose recurrences are related to intercourse, postcoital prophylaxis may be preferable. In this case, women take an antibiotic after intercourse. (10)
UTIs Caused by ESBL-Producing Bacteria: What to Know
Currently, there’s an increased incidence of urinary tract infections due to extended-spectrum beta-lactamase (ESBL)-producing E. coli. This is particularly worrisome since these strains are resistant to many popular antibiotics. Those most at risk include individuals with urinary catheters, a history of recurrent UTIs, or recent antibiotic use. Not only are ESBL infections harder to treat, those with this type of infection are at greater risk for a potentially life-threatening infection called sepsis. (11)
Treating UTIs Caused by ESBL-Producing Bacteria
Antibiotics classified as carbapenems (mipenem, meropenem, doripenem, and ertapenem) are often the drug of choice when treating UTIs caused by ESBL-producing bacteria. Antimicrobials, such as nitrofurantoin, fosfomycin, amikacin, and cefepime, may also be an option. (12)
When to Contact Your Physician About Symptoms
If during the course of your treatment, your symptoms remain unchanged or worsen, or new symptoms arise, contact your healthcare provider immediately. It is also imperative to contact your physician if during treatment you develop:
- A fever of 100.5 degrees F or more
- Lower stomach pain
- Nausea and vomiting
- Contractions, if pregnant (13)
Taking Cranberry Juice for UTIs
It’s a long-held belief that consuming cranberry juice may help prevent and treat urinary tract infections. While it’s true that cranberries contain an active ingredient that can prevent adherence of bacteria to the urinary tract, there’s no evidence that cranberry products can treat a UTI. And there’s very little high-quality research on the topic of prevention, either. The most recent research, a study published in November 2016 in The Journal of the American Medical Association, found that among female nursing home residents, daily consumption of cranberry capsules resulted in no significant prevention of UTIs. (14)
But earlier research suggested that cranberry could possibly help reduce the risk of UTIs in women with recurrent UTIs, children, and people who use cranberry-containing products more than twice daily. (15)
Currently, consuming cranberry juice or supplements is not considered a first-line of prevention against urinary tract infections. Still, in most cases, it can’t hurt. After all, drinking plenty of liquids does dilute your urine and help spur more frequent urination, which flushes bacteria from the urinary tract, and helps to keep UTIs at bay.
The exception: Those who are taking blood-thinning medication, such as warfarin, should not consume cranberry juice.
Urinary tract infection in women – self-care
BATHING AND HYGIENE
To prevent future urinary tract infections, you should:
- Choose sanitary pads instead of tampons, which some doctors believe make infections more likely. Change your pad each time you use the bathroom.
- DO NOT douche or use feminine hygiene sprays or powders. As a general rule, DO NOT use any product containing perfumes in the genital area.
- Take showers instead of baths. Avoid bath oils.
- Keep your genital area clean. Clean your genital and anal areas before and after sexual activity.
- Urinate before and after sexual activity. Drinking 2 glasses of water after sexual activity may help promote urination.
- Wipe from front to back after using the bathroom.
- Avoid tight-fitting pants. Wear cotton-cloth underwear and pantyhose, and change both at least once a day.
The following improvements to your diet may prevent future urinary tract infections:
- Drink plenty of fluids, 2 to 4 quarts (2 to 4 liters) each day.
- DO NOT drink fluids that irritate the bladder, such as alcohol and caffeine.
Some women have repeated bladder infections. Your provider may suggest that you:
- Use vaginal estrogen cream if you have dryness caused by menopause.
- Take a single dose of an antibiotic after sexual contact.
- Take a cranberry supplement pill after sexual contact.
- Have a 3-day course of antibiotics at home to use if you develop an infection.
- Take a single, daily dose of an antibiotic to prevent infections.
Diagnosis and Management of Uncomplicated Urinary Tract Infections
Jump to section +
Many studies in the last decade have focused on the treatment length of standard therapies. A study11 comparing a three-day course of ciprofloxacin (Cipro) 100 mg twice daily, ofloxacin (Floxin) 200 mg twice daily, and trimethoprim-sulfamethoxazole (TMP-SMX; Bactrim, Septra) 160/800 mg twice daily, found that all three had comparable efficacy in managing uncomplicated UTI. Another study12 comparing a short course (three days) of ciprofloxacin (100 mg twice daily) with the more traditional seven-day course of TMP-SMX (160/800 mg twice daily), and nitrofurantoin (Furadantin) (100 mg twice daily) found that ciprofloxacin had superior bacteriologic eradication rates after short-term follow-up (four to six weeks). All three medications had similar eradication rates immediately after therapy.12 The study12 also found that treatment failures associated with nitrofurantoin were more common in nonwhite women older than 30 years, but researchers were unable to account for this difference.
E. coli’s resistance to TMP-SMX is an increasing problem across the United States.13 A recent article14 that reviewed data from The Surveillance Network (TSN) database reported thatE. coli had an overall resistance rate of 38 percent to ampicillin, 17.0 percent to TMP-SMX, 0.8 percent to nitrofurantoin, and 1.9 to 2.5 percent to fluoroquinolones. The article14 also reported thatE. coli strains resistant to TMP-SMX had a 9.5 percent rate of concurrent ciprofloxacin resistance versus a 1.9 percent rate of concurrent resistance to nitrofurantoin. Another review15 of data from TSN (January through September 2000) found that 56 percent ofE. coli isolates were susceptible to all tested drugs including ampicillin, cephalothin (Keflin), nitrofurantoin, TMP-SMX, and ciprofloxacin. Among the tested antimicrobials,E. coli had the highest resistance rate to ampicillin (39.1 percent), followed by TMP-SMX (18.6 percent), cephalothin (15.6 percent), ciprofloxacin (3.7 percent), and nitrofurantoin (1.0 percent).15 Resistance rates varied by region of the country. Of the more than 38,000 isolates, 7.1 percent had a multidrug resistance.15 A 1999 regional analysis16 of the United States showed that resistance to TMP-SMX was highest in the Western-Southern-Central regions, with a 23.9 percent resistance rate. The Pacific and Mountain regions had a 21.8 percent resistance rate, and the South Atlantic region had a 19.7 percent resistance rate.16 Resistance rates in southern Europe, Israel, and Bangladesh reportedly have been as high as 30 to 50 percent.4
Fluoroquinolones have become popular treatments for patients with uncomplicated UTI because ofE. coli’s emerging resistance to other common medications. The reported resistance rate ofE. coli to ciprofloxacin is still very low at less than 3 percent.13 The IDSA guidelines recommend the use of fluoroquinolones (e.g., ciprofloxacin, fleroxacin , norfloxacin , and ofloxacin) as first-line agents in communities with greater than 10 to 20 percent resistance rates to TMP-SMX.17 An economic analysis4 found that a three-day regimen of ciprofloxacin was more cost-effective than a three-day regimen of TMP-SMX if the resistance rate to that drug was 19.0 percent or greater.4 A study13 comparing the newest formulation of extended-release ciprofloxacin (500 mg daily for three days) with traditional ciprofloxacin (250 mg twice daily for three days) showed equivalent clinical cure rates. A 1995 study18 comparing multidose regimens of ciprofloxacin showed that the minimal effective dosage was 100 mg twice daily. Another study19 compared a single 400-mg dose of gatifloxacin (Tequin), with three-day regimens of gatif loxacin (200 mg twice daily) and ciprof loxacin (100 mg twice daily). The single-dose therapy had a clinical response rate equivalent to the two three-day regimens. Gatifloxacin is also expected to be 1,000 times less likely than older fluoroquinolones to become resistant because of its 8-methoxy structure.19
Fosfomycin (Monurol) is another treatment option for patients with UTI. The U.S. Food and Drug Administration (FDA) indicates fosfomycin for the treatment of women with uncomplicated UTI. A study20 comparing a single dose of fosfomycin (3 g) with a seven-day course of nitrofurantoin (100 mg twice daily) showed similar bacteriologic cure rates (60 versus 59 percent, respectively).20 Fosfomycin is bactericidal and concentrates in the urine to inhibit the growth of pathogens for 24 to 36 hours.20 When fosfomycin entered the market in 1997, unpublished studies submitted to the FDA found that it was significantly less effective in eradicating bacteria than seven days of ciprofloxacin or 10 days of TMP-SMX (63 percent, 89 percent, and 87 percent eradication rates, respectively).21
Cephalosporins, including cephalexin (Keflex), cefuroxime (Ceftin), and cefixime (Suprax), can also manage UTIs. Increasing resistance, however, has limited their effectiveness.2 The broad spectrum of this class also increases the risk of vulvovaginal candidiasis. Cephalosporins are pregnancy category B drugs, and a seven-day regimen can be considered as a second-line therapy for pregnant women.2 Table 1 summarizes the possible treatments in patients with UTI.
Antimicrobial Agents for the Management of Uncomplicated UTIs
URI – urinary tract infection; TMP-SMX = trimethoprim-sulfamethoxazole.
*—Cost for complete course of therapy, based on average wholesale cost, based on Red Book, Montvale, N.J.: Medical Economics Data, 2004.
†—One double-strength tablet.
URI – urinary tract infection; TMP-SMX = trimethoprim-sulfamethoxazole.
*—Cost for complete course of therapy, based on average wholesale cost, based on Red Book, Montvale, N.J.: Medical Economics Data, 2004.
†—One double-strength tablet.
Physicians commonly recommend nonpharmacologic options (e.g., drinking cranberry juice or water) to patients with cystitis. A Cochrane review22 found insufficient evidence to recommend the use of cranberry juice to manage UTI.
Similarly, no scientific evidence suggests that women with cystitis should increase their fluid intake, and some doctors speculate that increased fluid may be detrimental because it may decrease the urinary concentration of antimicrobial agents.17
Treating older women who have UTIs requires special consideration. A recent study23 compared a 10-day course of ciprofloxacin (250 mg twice daily) with a 10-day course of TMP-SMX (160/800 mg twice daily). The study, which included 261 outpatient and institutionalized women with an average age of approximately 80 years, showed a 96 percent bacteriologic eradication rate with ciprofloxacin compared with an 80 percent eradication rate with TMP-SMX for the three most common isolates.23 Although the IDSA did not study postmenopausal women specifically, its review found that evidence supports the use of a seven-day antibiotic regimen for older women. The three-day therapy had a higher failure rate when compared with the seven-day regimen.24 A Cochrane review25 found insufficient evidence to recommend for or against short- versus long-term (seven to 10 days) treatment of uncomplicated UTIs in older women.
The incidence of UTI in men ages 15 to 50 years is very low, and little evidence exists on treating them. Risk factors include homosexuality, intercourse with an infected woman, and lack of circumcision. The limited available data are similar on two key points. First, the data show that men should receive the same treatment as women with the exception of nitrofurantoin, which has poor tissue penetration.17 Second, a minimum of seven days is the recommended treatment length, because the likelihood of complicating factors is higher than in women.5,17
UTI Antibiotics: Treatment For Urinary Tract Infection
Here is where we lay out everything you need to know about UTI antibiotics. If you’ve ever googled questions like…
Should I take Amoxicillin for UTI?
What are the best antibiotics for UTI?
Is Macrobid for UTI appropriate?
What happens if antibiotics don’t work for UTI?
Can you treat a UTI without antibiotics?
This article is for you. Even if you haven’t googled any of these, but have questions about antibiotics for UTI, this should have you covered.
Article Quick Links
- How UTI antibiotics are selected.
- What happens if antibiotics don’t work for UTI?
- My UTI test results are negative, what now?
- Do I have recurrent UTI or Interstitial Cystitis?
- Can you break the UTI antibiotic treatment cycle?
We find people discuss UTI antibiotics as though this represents a single treatment option. In reality, UTI antibiotics refers to a whole range of different drugs and doses, selected for specific reasons.
Knowing why certain antibiotics are helpful and others aren’t will give you more control over your own treatment. So let’s start at the very beginning. That way you can confirm the knowledge you already have, then expand on it.
UTI Treatment Antibiotics Overview
When faced with an uncomplicated urinary tract infection, your three main treatment options are antibiotics, natural remedies, or riding it out with nothing but water.
Can you take just any antibiotic for bladder infection?
The short and very decisive answer to that is no.
Every antibiotic is processed by our bodies differently. Some antibiotics, when taken orally, will never pass through the urinary tract. Or if they do, it is in such small amounts as to be completely ineffective.
Self-prescribing antibiotics could result in you taking medication that has zero positive impact, and possibly negative side effects.
Even if google tells you that whatever you have on hand does indeed pass through the urinary tract, do you know what types of bacteria it treats? More importantly, do you know which bacteria (or other pathogens) are causing your symptoms?
Most people don’t have the answers to either of these questions when they opt to self-treat a UTI. Below we’ve provided crucial information for you to consider.
How UTI Antibiotics Are Selected
Clinical and therapeutic guidelines for urinary tract infections guide medical practitioners on how to make a diagnosis. On top of this, the guidelines may help them select an appropriate treatment.
However, when it comes to choosing an antibiotic to treat any infection, there is a whole long list of things that can influence a doctor’s decision:
Diagnosis and Treatment of Acute Uncomplicated Cystitis
Without accurate test results, none of these things mean much, and the choice of any antibiotic is really just an educated guess.
UTI Antibiotics Effectiveness
Currently, there is no testing method that allows a medical practitioner to find out what is causing the infection when you show up at a clinic with a UTI. They rely on their experience, your awareness of your own body and symptoms, and at times, a strip test.
If you’ve read through our testing section, you’ll know this strip test is not designed to reveal what is causing your infection. It is only a tool to help identify whether there is an infection present. And it is a highly inaccurate tool.
So let’s recap. Your doctor can fairly accurately deduce whether you have a UTI, but at the time you show up at the clinic, three things remain unknown:
- Which bacterium or other pathogen is causing your infection (and there may be multiple)
- Which classes of antibiotic are appropriate for use on that bacterium
- How resistant that bacterium is to the different antibiotic classes
If your urine is tested, and the test is accurate (see our section on testing inaccuracy), all three of these can be answered. But this takes 2-3 days (see below for what happens then).
First Line UTI Antibiotics: A Best Guess Treatment
If you are prescribed a UTI treatment antibiotic when you show up at a clinic, it can only be selected according to the following criteria:
- What type of bacteria is most likely to have caused an uncomplicated UTI, given the region you are based in
- Which antibiotic the guidelines recommend for treating that most common type of bacteria
In the US, we have a rough idea of the most common causes of UTIs. E.coli is currently considered the most likely cause, and antibiotic resistance patterns are monitored in each region. This means doctors have access to information that allows them to narrow down which antibiotic is likely to be effective for a UTI caused by E.coli in their particular region.
If your doctor requests a urine sample for lab testing, it is probable they will also prescribe the first line antibiotic for your region. In doing this, they are hedging their bets while they wait for your test results.
Can I Change UTI Antibiotics?
The probability that the first line antibiotic will be effective is relatively high. But what happens if UTI antibiotics don’t work?
This is where that sample that was sent off for testing should help.
In the event your symptoms are not reduced, the lab test should identify which antibiotic will work better. In order to identify which antibiotic is likely to be effective, antibiotic susceptibility testing is conducted.
What is antibiotic susceptibility?
Simply put, antibiotic susceptibility is a measure of how sensitive a particular type of bacterium is to a particular antibiotic, or to a range of different antibiotics.
Antibiotic susceptibility testing is the practical application of this. In the lab, different antibiotics are physically applied to the bacteria found in your sample. This is then observed, and it is noted whether the antibiotic inhibits the growth of the bacteria, and if so, by how much.
The results of an antibiotic susceptibility test can help your doctor choose which antibiotic to recommend, particularly when the first round of treatment failed.
Although antibiotic susceptibility testing is helpful in theory, if you’ve read our section on testing, you’ll know that this process is not foolproof. And if an infection has become chronic or embedded, even a short course of the right antibiotic will not address the underlying infection.
Adverse Effects Of UTI Antibiotics And Specific Patient Factors
If you’ve ever read the leaflet that comes with your UTI antibiotics, you will know there are many side effects that can occur with antibiotic use. Certain people react to certain antibiotics, and some antibiotics are much more likely to cause side effects than others.
Side Effects Of Common Antibiotics Used To Treat Uncomplicated UTI
|Antimicrobial Agent (Brand)||Duration Of Course||Possible Side Effects|
|Trimethoprim–sulfamethoxazole (Bactrim, Septra)||3 days||Fever, rash, photosensitivity, neutropenia, thrombocytopenia, anorexia, nausea and vomiting, pruritus, headache, urticaria, Stevens–Johnson syndrome, and toxic epidermal necrosis|
|Trimethoprim (Trimpex, Primsol)||3 days||Rash, pruritus, photosensitivity, exfoliative dermatitis, Stevens–Johnson syndrome, toxic epidermal necrosis, and aseptic meningitis|
|Nitrofurantoin monohydrate/macrocrystals (Macrobid)||7 days||Anorexia, nausea, vomiting, hypersensitivity, peripheral neuropathy, hepatitis, hemolytic anemia, and pulmonary reactions|
|Fosfomycin tromethamine (Monurol)||Single dose||Diarrhea, nausea, vomiting, rash, and hypersensitivity|
|Amoxicillin and Clavulanate potassium (Augmentin, Augmentin ES-600, Augmentin XR)||Varies||Hives or welts, itching, itching of the vagina or genital area, pain during sexual intercourse, redness or rash of the skin, thick, white vaginal discharge with no odor or with a mild odor, bloody or cloudy urine, fever, greatly decreased frequency of urination or amount of urine, seizures, swelling of the feet or lower legs|
|3 days|| This class of antibiotics is known as fluoroquinolones and has been linked to serious side effects:
Nausea, diarrhea, headache, dizziness, lightheadedness, trouble sleeping, rash, confusion, seizures, restlessness, Achilles tendon rupture, severe hypersensitivity, numbness in the arms or legs, confusion, hallucinations, hypoglycemia that can lead to coma, and hyperglycemia.
Source: Treatment of Urinary Tract Infections in Nonpregnant Women
Are Fluoroquinolones Safe For Urinary Tract Infection?
The FDA has released numerous warnings advising against the use of fluoroquinolones.
FDA Drug Safety and Availability
FDA-approved fluoroquinolones include levofloxacin (Levaquin), ciprofloxacin (Cipro), ciprofloxacin extended-release tablets, norfloxacin (Noroxin), moxifloxacin (Avelox), ofloxacin and gemifloxacin (Factive) – three of which are on the list of common antibiotics above.
As you can see above, side effects from antibiotics can get quite serious, so this is an important consideration.
Although one class of antibiotic may be considered the most effective for a particular type of bacteria, it may also come with an increased chance of severe side effects. This may mean for example, that Cipro for UTI is not your best option if there are other, non-fluoroquinolone antibiotics to choose from.
In this case, your doctor may opt for an antibiotic that has a reduced chance of success but is much safer.
UTI Antibiotics Resistance Rates
The breakdown of causes of urinary tract infections is not the same the world over.
While the same major groups of bacteria are generally identified everywhere, the percentage of infections caused by each, and the resistance of each to particular antibiotics is often different, depending on the region.
To put it simply, an antibiotic that is considered effective in one region may be considered less effective in another.
For this reason, each region has its own recommendations for first line antibiotics for urinary tract infections.
As we covered above, doctors use these recommendations to select which antibiotic to prescribe in the absence of conclusive test results. Recommendations change over time as bacterial resistance and prevalence changes. So medical practitioners need to keep up with the latest information.
It’s a tough job keeping up, and in reality, it is thought that up to 50% of antibiotic prescriptions in the United States continue to be unnecessary or inappropriate. This figure applies not only to UTI antibiotics, but to all prescriptions for antibiotics.
UTI Antibiotics Cost And Availability
Although one antibiotic may be considered more effective than another, it isn’t always realistic for your doctor to prescribe it. The preferred antibiotic may not be available in your region, or a high cost may outweigh the potential benefit.
Your doctor has to weigh up all these factors and make a decision on how to treat your UTI.
Without test results that clearly specify which type of pathogen is causing your infection, and how susceptible that particular pathogen is to different types of treatment, the decision is based on probability, reason and educated guesses.
This brings us, once again, back to the issue of ineffective antibiotic treatment and its possible contribution to the recurrence of urinary tract infections.
Ineffective antibiotic treatment may allow bacteria to increase their resistance to that type of antibiotic. As the antibiotic resistance of a bacterium grows, it becomes harder to treat. At this point it is even more important to test for its susceptibility to future treatment options.
Given that test results take 2-3 days, your doctor must either prescribe an antibiotic without knowing what is causing your UTI, or advise you to wait until the test results come back.
When prescribing UTI antibiotics, it is crucial for a doctor to select the right antibiotic, at the right dose, for the right amount of time. For all this to be possible, they must also make the correct diagnosis. And to do that, accurate testing is essential.
Why Aren’t My UTI Antibiotics Working?
What happens if your antibiotics don’t work for UTI?
There are a number of reasons your UTI antibiotics may not be working to eradicate your UTIs for good:
- You may not be taking the right antibiotic to treat the specific cause of your UTI
- Your symptoms may be caused by more than one organism, and antibiotic susceptibility testing for the entire bacterial community may be more relevant
- The duration of your treatment may be insufficient
- Your UTI symptoms may not be caused by bacteria
- An embedded, antibiotic-resistant infection involving a biofilm may be present in your bladder, requiring specialized, longer term treatment (see one example here)
In all of these scenarios, the only way to find an answer is to get accurate testing to identify the cause of your symptoms. Unfortunately, standard testing can be very inaccurate, and you may find yourself with negative test results despite your acute symptoms.
The Problems With Frequent Antibiotic Use
Our own research has shown that many females with recurrent UTIs have taken the same antibiotic for years. For some this can mean every few weeks; for others every few months.
The longer you suffer from recurrent UTIs, the muddier the waters of UTI treatment antibiotics can seem. After all, if the treatment options you’ve tried have failed to prevent further UTIs, are any of them really working?
For many people, taking UTI antibiotics frequently is concerning. Yet without having found an effective alternative, antibiotics are still their first port of call at the onset of a UTI.
On a basic level, frequent antibiotic use means organizing multiple prescriptions, planning ahead and spending money. But there is also serious concern around antibiotic-resistant superbugs, destroying your gut flora, and whether frequent antibiotic use even helps.
And as we mentioned in our section on what causes UTIs, there is enough evidence to suggest that ineffective antibiotic use could be a major contributor to the formation of chronic infection, embedded in the bladder wall.
These types of infections typically involve biofilms – communities of bacteria that are very difficult to treat. The presence of biofilms can cause your symptoms to come and go, making you feel as though you get better, only to get another UTI…
Frequent antibiotic use that does not effectively treat chronic infection, can result in increased bacterial resistance, which again makes treatment more difficult.
Despite this, some of our community members have told us they reach a point where none of this matters enough to make them seriously reconsider their treatment. They are in pain, and they believe UTI antibiotics help ease it quickly.
Recurrent UTIs interfere with their daily lives and they rely on their antibiotics to help them get back to normal quickly.
No other solution has been offered to them, so UTI antibiotics become the only trusted weapon in a sea of remedies.
If this sounds familiar, it’s time to make sure you understand exactly what you’re taking and why. Hopefully we can teach you something you don’t already know.
My UTI Test Results Are Negative, What Now?
In an ideal situation, urinary tract infections would be easy to diagnose…
Your urine would be tested, the test would show what pathogen is causing the infection, and susceptibility testing would indicate the perfect antibiotic or other treatment for that pathogen.
Your doctor would prescribe the right treatment, your UTI would clear up, and you’d never have to think about it again. No more recurrent UTIs.
If you’re reading this site, we’re guessing there’s a good chance you have personal experience that is quite contrary to that ideal scenario.
So what happens when you get tested and the test results come back negative for a UTI?
Action To Take When You Get A Negative Test
If your test comes back negative, but you still have symptoms, the conclusion should be that further investigation is needed, NOT that the symptoms are not indicative of an infection.
Dr Jon Rees, Chair, Primary Care Urology Society, UK
If your UTI test is negative, it could very well be that the test is wrong.
First, it pays to understand why a test may be negative, despite your symptoms. Discussing this with your doctor will be more fruitful if you know what you’re talking about.
So we’ve gone into this in great detail in our UTI testing section.
Second, you should be aware that medical practitioners rely on guidelines to guide their decisions. Unfortunately, most guidelines used by medical practitioners do not cover the inaccuracies of current UTI testing methods.
This means it is entirely possible your doctor has no knowledge of the issues with standard testing, and may not recommend investigating further. If you’d like to share a reference with your doctor, one set of guidelines that does cover the issues with standard UTI testing, can be found here.
You know your body. If you have symptoms of a UTI but your test results say otherwise, you have the right to pursue further testing. You can discuss this with your doctor if you feel comfortable doing so.
Alternatively, you can look into private, independent testing; or seek out a practitioner that specializes in chronic urinary tract conditions.
Do I Have Recurrent UTI Or Interstitial Cystitis?
One study found that 74% of females with Interstitial Cystitis had previously been diagnosed with recurrent UTI.
The diagnosis of a single UTI becomes a diagnosis of recurrent UTI once you have experienced at least three UTIs in the last 12 months or at least two within the previous 6 months.
A diagnosis of recurrent UTIs can be indefinite. We’ve interviewed people who have been diagnosed with recurrent UTIs for more than 20 years, with their treatment never changing.
Some females report a recurrence every time they have sex. Others find it happens when they feel particularly dehydrated, or after intense exercise. And then there are the recurrences that don’t seem linked to anything except time. Some individuals suffer the symptoms of an acute UTI every 4-8 weeks, like clockwork.
In the absence of positive test results, many females will go on to be diagnosed with Interstitial Cystitis (IC). Depending on the knowledge of your medical practitioner and your own research, you may or may not have heard of this term.
The last part of that definition is important. It implies that IC can be diagnosed once UTI test results come back negative. That in itself is a little scary.
Can You Test For Interstitial Cystitis?
At a certain point, when UTI tests fail to identify a bacterial cause for symptoms, a diagnosis of recurrent UTI is escalated to IC for many individuals.
We know standard UTI testing methods are inaccurate. So there is a good chance a significant number of people are misdiagnosed with IC after receiving a false-negative on their test results. They may have an infection that testing has simply failed to pick up.
A number of researchers now believe many cases of Interstitial Cystitis may indeed be caused by bacteria that standard UTI testing has failed to identify.
We’ve gone into more detail about Interstitial Cystitis testing and treatment here.
If you have received inconclusive or negative test results, despite symptoms of a UTI, we encourage you to keep pushing for an answer. Seek better testing and find a practitioner who is willing to work with you.
Antibiotics For UTI And Interstitial Cystitis (IC)
One major difference we see between the diagnosis of recurrent UTI and Interstitial Cystitis is the treatment prescribed.
Females in the recurrent UTI boat are very likely to be prescribed UTI antibiotics for each acute episode, just as they would be for their first ever UTI. This happens whether or not their urine has been tested, and whether or not such testing provides a positive result.
Females diagnosed with IC, on the other hand, are not treated with antibiotics. The guidelines published by the American Urological Association in 2011 do not recommend antibiotic treatment for IC.
Given that almost three quarters of females diagnosed with IC were first diagnosed with recurrent UTIs, and that the diagnosis can literally change overnight, there is something obviously wrong here.
One or both of these groups are not receiving appropriate treatment. And it would seem that neither group has access to accurate testing.
Can You Break The UTI Antibiotic Treatment Cycle?
We’ve been chatting to females with recurrent UTIs for a few years now. They’ve helped us map out their treatment experiences. It looks a little something like this – maybe you can find your own story in the flow.
At any point shown in pink, individuals tend to either re-enter the loop, or resort to figuring things out on their own. You’ll also notice that antibiotics appear numerous times in these looped experiences.
Most of our interviewees indicated they have not received conclusive test results, or are not sure if their urine has ever been tested in a lab.
Many have lived with their own sets of chronic symptoms for years. Their experiences are as unique as they are alike.
Then there are those that break the cycle. And they have some valuable lessons to share. When we asked what allowed them to break free of the infinite loop of UTI antibiotics, these are the insights we heard:
- If you disagree with your doctor’s diagnosis, pursue a second, third or fourth opinion.
- Find a practitioner who understands chronic bladder infection and has shown success in treating patients.
- Take responsibility for your own health, and make the difficult changes you know you should make.
- Don’t look for a band-aid. Seek the root cause of your symptoms, and work with a practitioner that treats the body as a whole.
- Commit to getting well, and remain with your treatment as long as necessary.
A big part of the journey to recovery is knowledge. We hope we can help with this.
We’ve provided information on how chronic urinary tract infection can begin, why you can’t rely on standard UTI testing, and recurrent UTI treatment options, among other topics. We’ll continue to expand our site, and we’d also love to hear from you.
Share your questions and comments below, or get in touch with our team.
Which Antibiotic Will Work Best?
Your doctor will take a urine sample to confirm that you have a UTI. Then the lab will grow the germs in a dish for a couple of days to find out which type of bacteria you have. This is called a culture. It’ll tell your doctor what type of germs caused your infection. He’ll likely prescribe one of the following antibiotics to treat it before the culture comes back:
- Ceftriaxone (Rocephin)
- Cephalexin (Keflex)
- Ciprofloxacin (Cipro)
- Fosfomycin (Monurol)
- Levofloxacin (Levaquin)
- Nitrofurantoin (Macrodantin, Macrobid)
- Trimethoprim/sulfamethoxazole (Bactrim, Septra)
Which medication and dose you get depends on whether your infection is complicated or uncomplicated.
“Uncomplicated” means your urinary tract is normal. “Complicated” means you have a disease or problem with your urinary tract. You could have a narrowing of your ureters, which are the tubes that carry urine from your kidneys to your bladder, a narrowing in the urethra which transports urine from the bladder out of the body, or, you might have a blockage like a kidney stone or an enlarged prostate (in men).
To treat a complicated infection, your doctor might prescribe a higher dose of antibiotics. If your UTI is severe or the infection is in your kidneys, you might need to be treated in a hospital or doctor’s office with high-dose antibiotics you get through an IV.
Your doctor will also consider these factors when choosing an antibiotic:
- Are you pregnant?
- Are you over age 65?
- Are you allergic to any antibiotics?
- Have you had any side effects from antibiotics in the past?
Antibiotics are medicines that can kill bacteria. Doctors often use antibiotics to treat urinary tract infections (UTIs). The main symptoms of UTIs are:
- A burning feeling when you urinate.
- A strong urge to urinate often.
However, many older people get UTI treatment even though they do not have these symptoms. This can do more harm than good. Here’s why:
Antibiotics usually don’t help when there are no UTI symptoms.
Older people often have some bacteria in their urine. This does not mean they have a UTI. But doctors may find the bacteria in a routine test and give antibiotics anyway.
The antibiotic does not help these patients.
- It does not prevent UTIs.
- It does not help bladder control.
- It does not help memory problems or balance.
Most older people should not be tested or treated for a UTI unless they have UTI symptoms. And if you do have a UTI and get treated, you usually don’t need another test to find out if you are cured. You should only get tested or treated if UTI symptoms come back.
Antibiotics have side effects.
Antibiotics can have side effects, such as fever, rash, diarrhea, nausea, vomiting, headache, tendon ruptures, and nerve damage.
Antibiotics can cause future problems.
Antibiotics can kill “friendly” germs in the body. This can lead to vaginal yeast infections. It can also lead to other infections, and severe diarrhea, hospitalization, and even death.
Also, antibiotics may help “drug resistant” bacteria grow. These bacteria are harder to kill. They cause illnesses that are harder to cure and more costly to treat. Your doctor may have to try several antibiotics. This increases the risk of complications. The resistant bacteria can also be passed on to others.
Antibiotics can be a waste of money.
Prescription antibiotics can cost from $15 to more than $100. If you get an infection from resistant bacteria, you may need more doctor visits and medicines that cost more.
When should older people take antibiotics for a UTI?
If you have UTI symptoms, antibiotics can help.
- The most common UTI symptoms are a painful, burning feeling when you urinate and a strong urge to “go” often.
- Other UTI symptoms in older people may include fever, chills, or confusion. Along with these symptoms, there is usually pain on one side of the back below the ribs or discomfort in the lower abdomen. There may be a change in the way the urine looks or smells.
Some kinds of surgery can cause bleeding in the urinary tract—for example, prostate surgery and some procedures to remove kidney stones or bladder tumors. If you are going to have this surgery, you may need testing and treatment for bacteria in urine.
This report is for you to use when talking with your health-care provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.
© 2017 Consumer Reports. Developed in cooperation with the American Geriatric Society.