What is the treatment for a Urinary Tract Infection (UTI)?

From the Guidelines

The treatment for a UTI should involve short-course antibiotics, with options including nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole for 3 days, or fosfomycin as a single dose for uncomplicated cystitis, and fluoroquinolones or trimethoprim-sulfamethoxazole for 14 days for uncomplicated pyelonephritis. When considering treatment options, it's essential to note that the American College of Physicians recommends short-course antibiotics for UTIs, as seen in the 2021 study published in the Annals of Internal Medicine 1. The study suggests that for women with uncomplicated bacterial cystitis, clinicians should prescribe short-course antibiotics with either nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole for 3 days, or fosfomycin as a single dose. For men and women with uncomplicated pyelonephritis, the recommendation is to prescribe short-course therapy either with fluoroquinolones or trimethoprim-sulfamethoxazole for 14 days, based on antibiotic susceptibility 1. Some key points to consider when treating UTIs include:

• The most common cause of UTIs is Escherichia coli, which accounts for more than 75% of all bacterial cystitis 1
• Empirical antibiotics should target this organism
• Fluoroquinolones are highly efficacious but have a high propensity for adverse effects and should be reserved for patients with a history of resistant organisms 1
• It's crucial to complete the entire course of antibiotics, even if symptoms improve, and to drink plenty of water to help flush bacteria from the urinary system.

From the FDA Drug Label

1. 9 Complicated Urinary Tract Infections: 5 Day Treatment Regimen Levofloxacin tablets are indicated for the treatment of complicated urinary tract infections due to Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis
2. 10 Complicated Urinary Tract Infections: 10 Day Treatment Regimen Levofloxacin tablets are indicated for the treatment of complicated urinary tract infections (mild to moderate) due to Enterococcus faecalis, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or Pseudomonas aeruginosa
3. 11 Acute Pyelonephritis: 5 or 10 Day Treatment Regimen Levofloxacin tablets are indicated for the treatment of acute pyelonephritis caused by Escherichia coli, including cases with concurrent bacteremia
4. 12 Uncomplicated Urinary Tract Infections Levofloxacin tablets are indicated for the treatment of uncomplicated urinary tract infections (mild to moderate) due to Escherichia coli, Klebsiella pneumoniae, or Staphylococcus saprophyticus.

The treatment for a UTI is levofloxacin tablets, which are indicated for the treatment of:

• Complicated urinary tract infections due to certain bacteria, such as Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis
• Acute pyelonephritis caused by Escherichia coli
• Uncomplicated urinary tract infections due to Escherichia coli, Klebsiella pneumoniae, or Staphylococcus saprophyticus 2

From the Research

Treatment Options for UTI

The treatment for urinary tract infections (UTIs) depends on the type and severity of the infection. According to 3, the recommended first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females is a 5-day course of nitrofurantoin, a 3-g single dose of fosfomycin tromethamine, or a 5-day course of pivmecillinam.

Antibiotic Resistance

• High rates of resistance for trimethoprim-sulfamethoxazole and ciprofloxacin preclude their use as empiric treatment of UTIs in several communities, particularly if patients who were recently exposed to them or in patients who are at risk of infections with extended-spectrum β-lactamases (ESBLs)-producing Enterobacteriales 3.
• Second-line options include oral cephalosporins such as cephalexin or cefixime, fluoroquinolones and β-lactams, such as amoxicillin-clavulanate 3.

Specific Treatment Options

• For UTIs due to AmpC- β -lactamase-producing Enterobacteriales, treatment options include nitrofurantoin, fosfomycin, pivmecillinam, fluoroquinolones, cefepime, piperacillin-tazobactam and carbapenems 3.
• For UTIs due to ESBLs-E coli, treatment oral options include nitrofurantoin, fosfomycin, pivmecillinam, amoxicillin-clavulanate, finafloxacin, and sitafloxacin 3.
• For UTIs caused by carbapenem-resistant Enterobacteriales (CRE), treatment options include ceftazidime-avibactam, meropenem/vaborbactam, imipenem/cilastatin-relebactam, colistin, fosfomycin, aztreonam and ceftazidime-avibactam, aztreonam and amoxicillin-clavulanate, aminoglycosides including plazomicin, cefiderocol, tigecycline 3.

Duration of Treatment

• According to 4, 3-5 days of treatment will suffice for uncomplicated UTIs.
• The goal of prevention of recurrent cystitis is to minimize the use of antimicrobials and there are several research efforts in progress to develop effective and safe antimicrobial-sparing preventive approaches for this common condition 5.

Importance of Diagnosis

• The diagnosis of UTI is usually easily made based on the clinical presentation, whereas the diagnosis in patients with complicated UTI is often more complex 5.
• Understanding the usual benign course of uncomplicated UTIs can help reduce antibiotic treatment in many cases, e.g. starting treatment by pain relief and awaiting the course of infection without antibiotics 4.

Nitrofurantoin as a Treatment Option

• Nitrofurantoin (NF) is a wide-spectrum antibiotic that is utilized widely to treat urinary tract infections as it usually stays active against drug-resistant uropathogen 6.
• The use of Nitrofurantoin has increased exponentially since new guidelines have repositioned it as first-line therapy for uncomplicated lower urinary tract infection (UTI) 6.