From the Guidelines
Urinary tract infections (UTIs) should be treated with short-course antibiotics, with the specific antibiotic and duration depending on the severity and location of the infection, as well as antibiotic susceptibility, as recommended by the American College of Physicians 1.
Uncomplicated Cystitis
For women with uncomplicated bacterial cystitis, clinicians should prescribe short-course antibiotics with either nitrofurantoin for 5 days, trimethoprim–sulfamethoxazole (TMP–SMZ) for 3 days, or fosfomycin as a single dose 1.
- The choice of antibiotic should target Escherichia coli, which accounts for more than 75% of all bacterial cystitis 1.
- Fluoroquinolones are highly efficacious in 3-day regimens but have a high propensity for adverse effects and should be reserved for patients with a history of resistant organisms 1.
Uncomplicated Pyelonephritis
In men and women with uncomplicated pyelonephritis, clinicians should prescribe short-course therapy either with fluoroquinolones (5 to 7 days) or TMP–SMZ (14 days) based on antibiotic susceptibility 1.
- Pyelonephritis is defined as inflammation of the renal parenchyma and occurs in more than 250,000 patients in the United States yearly, resulting in significant costs 1.
- The IDSA/ESCMID guideline recommends treatment durations depending on the type of antibiotic, including 5 days of nitrofurantoin, 3 days of TMP–SMX, or a single dose of fosfomycin for uncomplicated cystitis, and either an oral fluoroquinolone for 7 days or TMP–SMX for 14 days for uncomplicated pyelonephritis 1.
Prevention of Future UTIs
To prevent future UTIs, patients should urinate after sexual activity, wipe from front to back, stay hydrated, and consider cranberry supplements, although the evidence for their effectiveness is mixed 1.
- UTIs occur when bacteria, usually E. coli from the digestive tract, enter the urinary system through the urethra and multiply in the bladder.
- Symptoms of UTIs include burning during urination, frequent urination, cloudy or strong-smelling urine, and pelvic pain.
- If patients experience fever, back pain, or nausea, they should seek immediate medical attention as these symptoms suggest a kidney infection requiring more aggressive treatment.
From the FDA Drug Label
To reduce the development of drug-resistant bacteria and maintain the effectiveness of sulfamethoxazole and trimethoprim tablets and other antibacterial drugs, sulfamethoxazole and trimethoprim tablets should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to empiric selection of therapy Urinary Tract Infections For the treatment of urinary tract infections due to susceptible strains of the following organisms: Escherichia coli, Klebsiella species, Enterobacter species, Morganella morganii, Proteus mirabilis and Proteus vulgaris Data from 2 pivotal trials in 1,191 patients treated for either lower respiratory tract infections or complicated urinary tract infections compared a regimen of 875 mg/125 mg amoxicillin and clavulanate potassium tablets every 12 hours to 500 mg/125 mg amoxicillin and clavulanate potassium tablets dosed every 8 hours (584 and 607 patients, respectively).
UTI Treatment Options:
- Trimethoprim-sulfamethoxazole (PO) is indicated for the treatment of urinary tract infections due to susceptible strains of Escherichia coli, Klebsiella species, Enterobacter species, Morganella morganii, Proteus mirabilis, and Proteus vulgaris 2.
- Amoxicillin-clavulanate (PO) has been studied for the treatment of complicated urinary tract infections and has shown comparable bacteriological success rates in patients assessed 2 to 4 days immediately following end of therapy 3.
From the Research
Definition and Diagnosis of UTI
- Urinary tract infections (UTIs) are common bacterial infections, particularly in women 4.
- An acute uncomplicated UTI is a bacterial infection of the lower urinary tract with no sign of systemic illness or pyelonephritis in a noncatheterized, nonpregnant adult with no urologic abnormalities or immunocompromise 5.
- A self-diagnosis of a UTI with the presence of typical symptoms (e.g., frequency, urgency, dysuria/burning sensation, nocturia, suprapubic pain) is accurate enough to diagnose an uncomplicated UTI without further testing 5.
Treatment Options for UTI
- 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 6.
- First-line antibiotics include nitrofurantoin for five days, fosfomycin in a single dose, trimethoprim for three days, or trimethoprim/sulfamethoxazole for three days 5.
- Treatment options for UTIs due to ESBLs-E coli include nitrofurantoin, fosfomycin, pivmecillinam, amoxicillin-clavulanate, finafloxacin, and sitafloxacin 6.
- Parenteral treatment options for UTIs due to ESBLs-producing Enterobacteriales include piperacillin-tazobactam, carbapenems, ceftazidime-avibactam, and aminoglycosides including plazomicin 6.
Comparison of Treatment Options
- A randomized clinical trial found that 5-day nitrofurantoin resulted in a significantly greater likelihood of clinical and microbiologic resolution at 28 days after therapy completion compared to single-dose fosfomycin 7.
- Clinical resolution through day 28 was achieved in 70% of patients receiving nitrofurantoin vs 58% of patients receiving fosfomycin 7.