What are the medications for Urinary Tract Infection (UTI)?

From the Guidelines

The most effective treatment for urinary tract infections (UTIs) is antibiotics, with first-line medications including nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin, as recommended by the American College of Physicians in 2021 1. When it comes to treating UTIs, the primary goal is to eliminate the infection while minimizing the risk of complications and promoting quality of life.

Treatment Options

• Nitrofurantoin (100mg twice daily for 5 days) is a suitable choice for therapy due to its minimal resistance and efficacy comparable to trimethoprim-sulfamethoxazole 1.
• Trimethoprim-sulfamethoxazole (160/800 mg twice-daily for 3 days) is also an appropriate choice for therapy, given its efficacy and low resistance rates 1.
• Fosfomycin (3g in a single dose) is another option, although it may have inferior efficacy compared to standard short-course regimens 1.

Considerations

• The choice of antibiotic should be based on local resistance rates and the patient's medical history 1.
• Fluoroquinolones, such as ciprofloxacin, may be prescribed for more complicated UTIs, but their use should be reserved due to the risk of adverse effects 1.
• Treatment duration varies based on infection severity, with uncomplicated UTIs typically requiring 3-7 days of antibiotics while complicated infections may need 7-14 days 1.

Additional Recommendations

• Drinking plenty of water helps flush bacteria from the urinary system, and over-the-counter pain relievers like phenazopyridine can help manage pain and burning during urination while antibiotics take effect.
• It is essential to complete the full course of antibiotics even if symptoms improve to ensure the infection is fully cleared.
• UTIs are caused by bacteria entering the urinary tract, most commonly E. coli, and antibiotics work by killing these bacteria or preventing their reproduction. The most recent and highest quality study, published in 2021 by the American College of Physicians 1, provides the best guidance for treating UTIs, and its recommendations should be followed to ensure the best possible outcomes for patients.

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 dose for children with urinary tract infections or acute otitis media is 40 mg/kg sulfamethoxazole and 8 mg/kg trimethoprim per 24 hours, given in two divided doses every 12 hours for 10 days. For the treatment of traveler’s diarrhea, the usual adult dosage is 1 sulfamethoxacin and trimethoprim DS (double strength) tablet or 2 sulfamethoxazole and trimethoprim tablets every 12 hours for 5 days. 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 The clinical success and bacteriologic eradication rates in the Per Protocol population were similar between ciprofloxacin and the comparator group

Medications for UTI:

• Trimethoprim-sulfamethoxazole (PO): The usual adult dosage is 1 DS tablet every 12 hours for 10 to 14 days 2.
• Ciprofloxacin (PO): Can be used to treat complicated urinary tract infections (cUTI) and pyelonephritis in pediatric patients 1 to 17 years of age, although it is not a drug of first choice due to increased incidence of adverse events 3. Key points:
• The dosage and treatment duration may vary depending on the patient's age, weight, and renal function.
• It is essential to follow the recommended dosage regimen and consult a healthcare professional for proper diagnosis and treatment of UTI.

From the Research

Medications for UTI

• 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 4.
• 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 4.
• Second-line options include oral cephalosporins such as cephalexin or cefixime, fluoroquinolones and β-lactams, such as amoxicillin-clavulanate 4.
• Nitrofurantoin is a wide-spectrum antibiotic that is utilized widely to treat urinary tract infections as it usually stays active against drug-resistant uropathogen 5.
• The use of Nitrofurantoin has increased exponentially since new guidelines have repositioned it as first-line therapy for uncomplicated lower urinary tract infection (UTI) 5.

Treatment Options for Specific Types of UTIs

• Current treatment options for UTIs due to AmpC- β -lactamase-producing Enterobacteriales include nitrofurantoin, fosfomycin, pivmecillinam, fluoroquinolones, cefepime, piperacillin-tazobactam and carbapenems 4.
• Treatment oral options for UTIs due to ESBLs-E coli include nitrofurantoin, fosfomycin, pivmecillinam, amoxicillin-clavulanate, finafloxacin, and sitafloxacin 4.
• Parenteral treatment options for UTIs due to ESBLs-producing Enterobacteriales include piperacillin-tazobactam, carbapenems, ceftazidime-avibactam, ceftolozane-tazobactam, aminoglycosides, and fosfomycin 4.

Guideline Concordance and Antibiotic Resistance

• Guideline discordance continues in the treatment of uncomplicated urinary tract infections with the overuse of fluoroquinolones and the underuse of first-line antibiotic agents 6.
• The proportion of prescriptions for each antibiotic drug class were reported with 95% confidence intervals and compared with the Infectious Diseases Society of America guidelines, showing that fluoroquinolones were the most commonly prescribed antibiotic agents, followed by nitrofurantoin and trimethoprim-sulfamethoxazole 6.
• Actions such as educating physicians about antibiotic resistance and clinical practice guidelines and providing feedback on prescription habits are needed to increase guideline concordance and therefore reduce the use of fluoroquinolones 6.
• Oral antibiotics with comparatively lower resistance rates were amoxicillin/clavulanate, cefdinir, cefuroxime, and nitrofurantoin, while oral antibiotics with notably high resistance rates included trimethoprim-sulfamethoxazole, tetracycline, ciprofloxacin, levofloxacin, and cephalexin 7.