What medications are used to treat persistently recurrent Urinary Tract Infections (UTI) in the United States?

From the Guidelines

For persistently recurrent urinary tract infections (UTIs) in the United States, the recommended medications include:

• Nitrofurantoin: 50-100 mg orally, once daily, for 6-12 months, as a suppressive therapy 1.
• Trimethoprim-sulfamethoxazole: 80-160 mg/400-800 mg orally, once daily, for 6-12 months, as a suppressive therapy 1.
• Fosfomycin: as an alternative option, due to its effectiveness in treating UTIs with minimal collateral damage 1.

Alternatively, postcoital prophylaxis can be considered, using a single dose of:

• Nitrofurantoin: 50-100 mg orally 1.
• Trimethoprim-sulfamethoxazole: 80-160 mg/400-800 mg orally 1.

Important Considerations

It is essential to note that the choice of medication and duration of treatment should be individualized based on the patient's specific needs, medical history, and susceptibility patterns 1. Additionally, patients should be monitored for adverse effects and antibiotic resistance 1. The decision to use antibiotic prophylaxis must balance the need for prevention against the risk of adverse drug events, antimicrobial resistance, and microbiome disruption 1.

Non-Antibiotic Prevention Strategies

Other strategies to prevent UTIs include:

• Cranberry products: containing proanthocyanidin levels of 36 mg, which can reduce the recurrent UTIs in women, children, and individuals susceptible to UTIs 1.
• Vaginal estrogen: which can be used to reduce UTIs in postmenopausal women 1.
• Increased water intake: which can decrease UTIs in healthy women 1.
• Methenamine hippurate: which can be used as an antimicrobial-sparing intervention to reduce UTIs in patients without incontinence and a fully functional bladder 1.

From the FDA Drug Label

The usual adult dosage in the treatment of urinary tract infections is 1 sulfamethoxazole and trimethoprim DS tablet every 12 hours for 10 to 14 days

• Trimethoprim-sulfamethoxazole is used to treat urinary tract infections in adults.
• The dosage for children with urinary tract infections is 40 mg/kg sulfamethoxazole and 8 mg/kg trimethoprim per 24 hours, given in two divided doses every 12 hours for 10 days 2.
• Nitrofurantoin is also used to treat urinary tract infections, but the provided label does not specify the dosage regimen 3.
• For persistently recurrent UTI, the FDA label does not provide specific guidance on the treatment regimen.

From the Research

Medications for Recurrent UTIs

The following medications are used to treat persistently recurrent Urinary Tract Infections (UTIs) in the United States:

• Nitrofurantoin 4, 5, 6, 7
• Trimethoprim/sulfamethoxazole 4, 5, 6, 8
• Fosfomycin 4, 6
• Amoxicillin clavulanic acid 5
• Bactrim 5
• Pivmecillinam 6
• Cefepime 6
• Piperacillin-Tazobactam 6
• Ceftolozane-Tazobactam 6
• Ceftazidime-Avibactam 6

Prophylactic Antibiotics

Prophylactic antibiotics are also used to prevent recurrent UTIs, including:

• Nitrofurantoin 5, 6
• Trimethoprim/sulfamethoxazole 5, 6
• Bactrim 5

Treatment Duration

The treatment duration for recurrent UTIs varies, but typical durations include:

• 5 days for nitrofurantoin 4
• 3 days for trimethoprim/sulfamethoxazole 4
• 7 days for trimethoprim, trimethoprim/sulfamethoxazole, and nitrofurantoin in men with uncomplicated UTI 4
• Single dose for fosfomycin 4