What medications are used to treat recurrent Urinary Tract Infections (UTIs)?

From the Guidelines

For recurrent urinary tract infections (UTIs), antibiotic prophylaxis is a recommended treatment approach, with options including Nitrofurantoin, Trimethoprim-sulfamethoxazole, and Cephalexin 1.

Treatment Options

• Postcoital prophylaxis: Nitrofurantoin 50-100 mg or Trimethoprim-sulfamethoxazole 40/200 mg, taken as a single dose after sexual intercourse 1.
• Continuous prophylaxis: Nitrofurantoin 50-100 mg daily, Trimethoprim-sulfamethoxazole 40/200 mg daily, or Cephalexin 250 mg daily, for 6-12 months 1.
• Self-initiated treatment: Nitrofurantoin 100 mg twice daily for 5-7 days, Trimethoprim-sulfamethoxazole 160/800 mg twice daily for 3 days, or Ciprofloxacin 250 mg twice daily for 3 days, started at the onset of symptoms 1. It's essential to note that the choice of medication and duration of treatment should be individualized based on the patient's medical history, allergy profile, and local antibiotic resistance patterns 1. Additionally, patients with recurrent UTIs should be encouraged to practice good hygiene, stay hydrated, and consider other preventive measures, such as cranberry juice or probiotics, under the guidance of a healthcare provider 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 The recommended dosage for patients with documented Pneumocystis carinii pneumonia is 75 to 100 mg/kg sulfamethoxazole and 15 to 20 mg/kg trimethoprim per 24 hours given in equally divided doses every 6 hours for 14 to 21 days For the treatment of traveler’s diarrhea, the usual adult dosage is 1 sulfamethoxazole and trimethoprim DS (double strength) tablet or 2 sulfamethoxazole and trimethoprim tablets every 12 hours for 5 days CLINICAL STUDIES Complicated Urinary Tract Infection and Pyelonephritis – Efficacy in Pediatric Patients: Ciprofloxacin, administered I. V. and/or orally, was compared to a cephalosporin for treatment of complicated urinary tract infections (cUTI) and pyelonephritis in pediatric patients 1 to 17 years of age

Medications used to treat recurrent Urinary Tract Infections (UTIs) include:

• Trimethoprim-sulfamethoxazole (PO): for the treatment of urinary tract infections in adults and pediatric patients 2
• Ciprofloxacin (PO): for the treatment of complicated urinary tract infections and pyelonephritis in pediatric patients 1 to 17 years of age 3

From the Research

Medications for Recurrent Urinary Tract Infections (UTIs)

The following medications are used to treat recurrent UTIs:

• Nitrofurantoin 4, 5, 6, 7
• Trimethoprim 4, 5, 6, 7
• Cotrimoxazole 4, 5, 6
• Fosfomycin trometamol 5
• Cephalexin 4, 5
• Quinolones 4, 5
• Amoxicillin clavulanic acid 7
• Bactrim 7

Prophylaxis Regimens

Different prophylaxis regimens are used to prevent recurrent UTIs, including:

• Continuous long-term prophylaxis with low-dose antibiotics 4, 5, 6
• Postcoital single-dose prophylaxis 4, 5, 8
• Patient-initiated self-start therapy 4
• Vaginal prophylaxis with estriol 5, 6
• Cranberry products 5, 6
• Phytotherapeutics 6
• Mannose 6
• Urine acidification 6
• Acupuncture 6
• Inpatient rehabilitation 6

Efficacy of Prophylactic Antibiotics

Prophylactic antibiotics have been shown to reduce the recurrence rate of UTIs by:

• 95% 4
• 90% 5
• Reducing the number of uropathogens in the gut and vaginal flora 4, 5
• Reducing bacterial "fitness" 5
• Decreasing the rate of UTI during prophylaxis 8
• Reducing emergency room visits and hospital admissions due to UTIs 7