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

From the Guidelines

Treatment for a urinary tract infection (UTI) in females typically involves antibiotics for 3-7 days, with the most recent and highest quality study recommending nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole for 3 days, or fosfomycin as a single dose 1.

Key Considerations

• The American College of Physicians recommends short-course antibiotics for uncomplicated cystitis and pyelonephritis in women 1.
• First-line medications include nitrofurantoin (Macrobid) 100mg twice daily for 5 days, trimethoprim-sulfamethoxazole (Bactrim) DS twice daily for 3 days, or fosfomycin (Monurol) as a single 3-gram dose 1.
• Patients should drink plenty of water, urinate frequently, and complete the entire course of medication even if symptoms improve.
• Over-the-counter pain relievers like phenazopyridine (AZO) can help manage pain and burning during urination.

Prevention of Future UTIs

• Women should urinate after sexual activity, wipe from front to back after using the bathroom, stay hydrated, and avoid irritating feminine products.
• UTIs occur when bacteria, usually E. coli from the digestive tract, enter the urethra and multiply in the bladder.
• Antibiotics work by killing these bacteria, while increased fluid intake helps flush bacteria from the urinary system.

Further Evaluation

• If symptoms persist after treatment or recur frequently, further evaluation by a healthcare provider is necessary to rule out underlying complications or resistant organisms 1.

From the Research

Treatment Options for UTI in Females

• 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 2.
• Second-line options include oral cephalosporins such as cephalexin or cefixime, fluoroquinolones and β-lactams, such as amoxicillin-clavulanate 2.
• Current treatment options for UTIs due to AmpC- β -lactamase-producing Enterobacteriales include nitrofurantoin, fosfomycin, pivmecillinam, fluoroquinolones, cefepime, piperacillin-tazobactam and carbapenems 2.

Antibiotic Resistance and Treatment

• 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 2.
• Treatment options for UTIs caused by multidrug resistant (MDR)-Pseudomonas spp. include fluoroquinolones, ceftazidime, cefepime, piperacillin-tazobactam, carbapenems including imipenem-cilastatin/relebactam, meropenem, and fosfomycin, ceftolozane-tazobactam, ceftazidime-avibactam, aminoglycosides including plazomicin, aztreonam and ceftazidime-avibactam, cefiderocol, and colistin 2.

Dosing Strategies

• Twice-daily cephalexin is as effective as 4-times-daily dosing for uncomplicated urinary tract infections (uUTI) in females 3.
• A twice-daily dosing strategy may improve patient adherence 3.

Guideline Concordance

• The overall concordance rate with Infectious Diseases Society of America guidelines for the treatment of uncomplicated urinary tract infections in women was 58.4% 4.
• The most commonly prescribed antibiotic agents were fluoroquinolones, nitrofurantoin, and trimethoprim-sulfamethoxazole 4.
• Guideline discordance continues in the treatment of uncomplicated urinary tract infections with the overuse of fluoroquinolones and the underuse of first-line antibiotic agents 4.